Provider Demographics
NPI:1356974703
Name:JAYMES, KELLIE (LMT)
Entity type:Individual
Prefix:
First Name:KELLIE
Middle Name:
Last Name:JAYMES
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:307 INWOOD DR
Mailing Address - Street 2:
Mailing Address - City:BULLARD
Mailing Address - State:TX
Mailing Address - Zip Code:75757-5415
Mailing Address - Country:US
Mailing Address - Phone:903-574-9849
Mailing Address - Fax:
Practice Address - Street 1:151 US HIGHWAY 69 N STE 800
Practice Address - Street 2:
Practice Address - City:BULLARD
Practice Address - State:TX
Practice Address - Zip Code:75757-5184
Practice Address - Country:US
Practice Address - Phone:903-894-4404
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-13
Last Update Date:2020-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT109106225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist