Provider Demographics
NPI:1801542535
Name:GULLY, KACI (FNP-C)
Entity type:Individual
Prefix:
First Name:KACI
Middle Name:
Last Name:GULLY
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 HUTCHINS AVE STE C
Mailing Address - Street 2:
Mailing Address - City:BALLINGER
Mailing Address - State:TX
Mailing Address - Zip Code:76821-4453
Mailing Address - Country:US
Mailing Address - Phone:325-365-5737
Mailing Address - Fax:325-365-2405
Practice Address - Street 1:2001 HUTCHINS AVE STE C
Practice Address - Street 2:
Practice Address - City:BALLINGER
Practice Address - State:TX
Practice Address - Zip Code:76821-4453
Practice Address - Country:US
Practice Address - Phone:325-365-5737
Practice Address - Fax:325-365-2405
Is Sole Proprietor?:No
Enumeration Date:2022-02-22
Last Update Date:2022-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1071334363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner