Individual
SAMUEL KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
100 HILLCREST MEDICAL BLVD, WACO, TX 76712-8897
(254) 202-2000
Mailing address
PO BOX 844658, DALLAS, TX 75284-4658
(254) 724-2111
Taxonomy
Speciality
Code
Description
License number
State
367H00000X
Anesthesiologist Assistant
Primary
32697602
TX
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/06/2020
Last updated
01/27/2022
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