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Individual
KELLEY D ELLIS
Active
Individual
KELLEY D ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RNFA, CNOR
Taxonomy
Speciality
Code
Description
License number
State
163WM0705X
Medical-Surgical Registered Nurse
Primary
551667
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0672032
CIGNA
TX
01
—
7521427
AETNA
TX
01
—
89N921
BCBS OF TX
TX
Enumeration date
08/29/2006
Last updated
02/04/2019
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