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Organization
KELLCY MEDICAL GROUP
Active
Organization
KELLCY MEDICAL GROUP
Active
Other names
Simply Well Boutique Medicine
Organization subpart
No
Provider details
NPI number
Authorized official
TERI KELSO (PRACTICE ADMINISTRATOR)
(830) 620-7744
Entity
Organization
Contact information
Practice address
204 CAMP WILLOW RD, NEW BRAUNFELS, TX 78130-1805
(830) 620-7744
(830) 625-0353
Mailing address
204 CAMP WILLOW RD, NEW BRAUNFELS, TX 78130-1805
(830) 620-7744
(830) 625-0353
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1881813806
GROUP NPI
TX
Enumeration date
06/10/2024
Last updated
06/19/2024
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