# KLR PHYSICIAN GROUP

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- **Entity:** Organization
- **Status:** Active
- **Other names:** The KLR Physician Group
- **Organization subpart:** No

## Provider details

- **NPI number:** 1033506456
- **Authorized official:** KELLEE L RANDLE DO (CEO)
- **Authorized official phone:** (267) 981-0308

## Contact information

- **Practice address:** 3450 E. BROAD STREET, SUITE 120, MANSFIELD, TX 76063-7606
- **Practice address phone:** (267) 981-0308
- **Mailing address:** 3540 E BROAD ST STE 120, MANSFIELD, TX 76063-5633

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 313M00000X | Nursing Facility/Intermediate Care Facility | P3570 | TX | Yes |

## Other

- **Enumeration date:** 04/23/2015
- **Last updated:** 09/11/2025