Individual
MS. KELLY NICHOLE TABBERT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
6606 LBJ FWY, SUITE 200, DALLAS, TX 75240
(972) 715-5000
(972) 715-9976
Mailing address
PO BOX 840853, DALLAS, TX 75284-0853
(972) 715-5000
(972) 715-9976
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
718733
TX
367500000X
Certified Registered Nurse Anesthetist
Primary
AP124986
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
329482903
—
TX
01
—
8852UG
BCBS
TX
01
—
8990UF
BCBS
TX
01
—
P01446023
RR
TX
Enumeration date
07/31/2013
Last updated
06/30/2020
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