Provider Demographics
NPI:1801308556
Name:HARTMANN, KELLI KOVACH (MSN, RN, AGACNP-BC)
Entity type:Individual
Prefix:MRS
First Name:KELLI
Middle Name:KOVACH
Last Name:HARTMANN
Suffix:
Gender:F
Credentials:MSN, RN, AGACNP-BC
Other - Prefix:MISS
Other - First Name:KELLI
Other - Middle Name:NOEL
Other - Last Name:KOVACH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:1132 LAKESIDE DR
Mailing Address - Street 2:
Mailing Address - City:LAKEHILLS
Mailing Address - State:TX
Mailing Address - Zip Code:78063-6477
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6700 W IH 10
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78201-2009
Practice Address - Country:US
Practice Address - Phone:210-736-6700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-02
Last Update Date:2019-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP135682163WC0200X, 363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX380317301Medicaid
TX380317302OtherCSHNC