Provider Demographics
NPI:1811465313
Name:MORALES, KELLY C (FNP-C)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:C
Last Name:MORALES
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 1:187 VILLAGE EAST DR
Mailing Address - Street 2:
Mailing Address - City:LOS FRESNOS
Mailing Address - State:TX
Mailing Address - Zip Code:78566-3104
Mailing Address - Country:US
Mailing Address - Phone:956-517-5282
Mailing Address - Fax:
Practice Address - Street 1:605 MACO DR
Practice Address - Street 2:
Practice Address - City:HARLINGEN
Practice Address - State:TX
Practice Address - Zip Code:78550-8799
Practice Address - Country:US
Practice Address - Phone:956-428-2386
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-02
Last Update Date:2018-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP139461363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily