Provider Demographics
NPI:1184690083
Name:DUNCAN, KELLY HERNE (MD)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:HERNE
Last Name:DUNCAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:L
Other - Last Name:HERNE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:801 YORK ST
Mailing Address - Street 2:
Mailing Address - City:MANITOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:54220-4630
Mailing Address - Country:US
Mailing Address - Phone:920-663-9008
Mailing Address - Fax:920-684-1439
Practice Address - Street 1:2051 GREENHOUSE RD STE 270
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77084-7573
Practice Address - Country:US
Practice Address - Phone:281-665-4444
Practice Address - Fax:281-392-6766
Is Sole Proprietor?:No
Enumeration Date:2006-02-28
Last Update Date:2024-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL2317207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
3833541OtherAETNA HMO
P00264644OtherRR MEDICARE - BRAZORIA
8J9633OtherBCBS
7921718OtherAETNA PPO
8F0819OtherMEDICARE - BRAZORIA
TX8F4133Medicare PIN
TX8D7571Medicare PIN
TX8F0819Medicare PIN
3833541OtherAETNA HMO