Provider Demographics
NPI:1659656858
Name:HUNT, KELLY ALICIA (PAC)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:ALICIA
Last Name:HUNT
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:ALICIA HUNT
Other - Last Name:MOELLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:5310 HARVEST HILL RD STE 290
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75230-5826
Mailing Address - Country:US
Mailing Address - Phone:214-420-0672
Mailing Address - Fax:214-736-0512
Practice Address - Street 1:1806 E END BLVD N STE 1300
Practice Address - Street 2:
Practice Address - City:MARSHALL
Practice Address - State:TX
Practice Address - Zip Code:75670-0734
Practice Address - Country:US
Practice Address - Phone:903-757-8878
Practice Address - Fax:903-757-5985
Is Sole Proprietor?:No
Enumeration Date:2011-10-19
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA07980363A00000X
LAPA200513363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant