Individual
KELLY OFFUTT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
L2516
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
131964100
FIRSTCARE
TX
05
—
155204401
—
TX
05
—
155204402
—
TX
01
—
80803
SCOTT & WHITE
TX
01
—
8F9833
BCBS
TX
Enumeration date
11/18/2005
Last updated
01/07/2021
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