Provider Demographics
NPI:1265540793
Name:KELLCY, JULIA R (DO)
Entity type:Individual
Prefix:
First Name:JULIA
Middle Name:R
Last Name:KELLCY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 CAMP WILLOW RD
Mailing Address - Street 2:
Mailing Address - City:NEW BRAUNFELS
Mailing Address - State:TX
Mailing Address - Zip Code:78130-1805
Mailing Address - Country:US
Mailing Address - Phone:830-627-9208
Mailing Address - Fax:830-625-0353
Practice Address - Street 1:204 CAMP WILLOW RD
Practice Address - Street 2:
Practice Address - City:NEW BRAUNFELS
Practice Address - State:TX
Practice Address - Zip Code:78130-1805
Practice Address - Country:US
Practice Address - Phone:210-857-5934
Practice Address - Fax:830-625-0353
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2024-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK5088207R00000X, 208000000X, 207QH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative MedicineGroup - Multi-Specialty
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX433161-01OtherKELLCY MEDICAL GROUP MEDICAID #
TX8F7697OtherINDIVIDUAL PTAN #
TX1431736-01Medicaid
TX00343ROtherKELLCY MEDICAL GROUP MEDICARE NUMBER
TXOOY940OtherGROUP PTAN
TX8CR078OtherBC/BS OF TEXAS
TXP00903522OtherRR MEDICARE
TX433161-01OtherKELLCY MEDICAL GROUP MEDICAID #
TXOOY940OtherGROUP PTAN
TX8F7697OtherINDIVIDUAL PTAN #