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Individual

DENISE KELLUM

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PA-C

Contact information

Practice address
7323 MARBACH RD STE 104, SAN ANTONIO, TX 78227-1905
(210) 231-2586
(210) 231-2583
Mailing address
7323 MARBACH RD STE 104, SAN ANTONIO, TX 78227-1905
(210) 674-0257
(210) 369-9064

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA05852
TX

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1396908950
TX
01
1508813494
GROUP/BILLING NPI#
TX
01
363A00000X
INDIVIDUAL TAXONOMY
TX
01
PA05852
PHYSICIAN ASSISTANT LICENSE#
TX
Enumeration date
07/03/2008
Last updated
12/10/2025
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