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Individual
KELLY TANNER TEEL
Active
Individual
KELLY TANNER TEEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA07013
TX
363AM0700X
Medical Physician Assistant
PA07013
TX
363AS0400X
Surgical Physician Assistant
—
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
297624301
—
TX
05
—
297624302
—
TX
01
—
PA07013
TEXAS LICENSE
TX
Enumeration date
12/13/2010
Last updated
08/24/2015
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