Provider Demographics
NPI:1841820487
Name:LE NOIR, KELLEY PRATER (FNP-C)
Entity type:Individual
Prefix:MRS
First Name:KELLEY
Middle Name:PRATER
Last Name:LE NOIR
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:MS
Other - First Name:KELLEY
Other - Middle Name:MACKLIN
Other - Last Name:PRATER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:18568 FORTY SIX PKWY
Mailing Address - Street 2:STE 1001
Mailing Address - City:SPRING BRANCH
Mailing Address - State:TX
Mailing Address - Zip Code:78070-6878
Mailing Address - Country:US
Mailing Address - Phone:830-438-9300
Mailing Address - Fax:830-438-9002
Practice Address - Street 1:18568 FORTY SIX PKWY STE 1001
Practice Address - Street 2:
Practice Address - City:SPRING BRANCH
Practice Address - State:TX
Practice Address - Zip Code:78070-6878
Practice Address - Country:US
Practice Address - Phone:830-438-9300
Practice Address - Fax:830-438-9002
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-23
Last Update Date:2020-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP144726363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily