Provider Demographics
NPI:1720786387
Name:DUCKWORTH, KELLY
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:DUCKWORTH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:
Other - Last Name:OGLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1333 W MCDERMOTT DR STE 150
Mailing Address - Street 2:
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75013-3088
Mailing Address - Country:US
Mailing Address - Phone:972-332-8733
Mailing Address - Fax:972-332-8767
Practice Address - Street 1:1333 W MCDERMOTT DR STE 150
Practice Address - Street 2:
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75013-3088
Practice Address - Country:US
Practice Address - Phone:972-332-8733
Practice Address - Fax:972-332-8767
Is Sole Proprietor?:No
Enumeration Date:2023-02-22
Last Update Date:2023-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker