Individual
KELLI TWEDELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
5744 LBJ FWY STE 100, DALLAS, TX 75240-6322
(214) 466-2828
(214) 382-9798
Mailing address
PO BOX 3409, PFLUGERVILLE, TX 78691-3409
(513) 252-7792
(513) 904-5908
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
PA11922
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
382709902
—
TX
01
—
PA11922
TEXAS MEDICAL BOARD
TX
Enumeration date
04/02/2018
Last updated
09/21/2020
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