Individual
DAVID C KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
BEN HOGAN CENTER, 800 5TH AVE., SUITE 410, FORT WORTH, TX 76104
(817) 332-6092
(817) 332-6015
Mailing address
PO BOX 961205, FORT WORTH, TX 76161-1205
(817) 740-8400
(817) 332-6015
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA02492
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
181681101
—
TX
01
—
P00416662
RAILROAD MEDICARE
—
Enumeration date
07/17/2006
Last updated
02/18/2010
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