Organization
KELLY'S PRIMARY CARE, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JAYNIE CHAPA RN (ADMINISTRATOR)
(956) 583-0141
Entity
Organization
Contact information
Practice address
2009 N CONWAY AVE, MISSION, TX 78572-2965
(956) 583-0141
(956) 583-0143
Mailing address
2007 N CONWAY AVE, MISSION, TX 78572
(956) 583-0141
(956) 583-0143
Taxonomy
Speciality
Code
Description
License number
State
305R00000X
Preferred Provider Organization
Primary
006524
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000017300
—
TX
05
—
001012821
—
TX
05
—
185365701
—
TX
Enumeration date
02/22/2007
Last updated
06/07/2011
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