Individual
TODD LAWRENCE KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
155 MEMORIAL DR, PINEHURST, NC 28374-8710
(910) 715-2164
Mailing address
PO BOX 840853, DALLAS, TX 75284-0853
(713) 620-4000
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
K8775
TX
207LC0200X
Critical Care Medicine (Anesthesiology) Physician
Primary
2019-00087
NC
207LC0200X
Critical Care Medicine (Anesthesiology) Physician
K8775
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
037266604
—
TX
05
—
037266605
—
TX
05
—
1306927900
—
NC
05
—
1888397
—
LA
05
—
37266601
—
TX
01
—
8AC774
BLUE CROSS
TX
01
—
P00616427
MEDICARE RAILROAD
TX
Enumeration date
10/18/2006
Last updated
06/14/2023
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