Provider Demographics
NPI:1952588154
Name:KELLY, LISA MARIA (MD)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:MARIA
Last Name:KELLY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6006 LE MOYNE PASS LN
Mailing Address - Street 2:
Mailing Address - City:MISSOURI CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77459-1762
Mailing Address - Country:US
Mailing Address - Phone:281-352-8985
Mailing Address - Fax:281-352-8985
Practice Address - Street 1:6006 LE MOYNE PASS LN
Practice Address - Street 2:
Practice Address - City:MISSOURI CITY
Practice Address - State:TX
Practice Address - Zip Code:77459-1762
Practice Address - Country:US
Practice Address - Phone:281-352-8985
Practice Address - Fax:281-352-8985
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-30
Last Update Date:2014-08-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXL2367207Q00000X
TXE4201207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine