Individual
KELLIE MARIE REARDON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
1301 WONDER WORLD DR, SAN MARCOS, TX 78666-7533
(512) 753-3796
Mailing address
4680 COUNTY ROAD 419, YOAKUM, TX 77995-7049
(361) 741-2678
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
516912
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
142619904
—
TX
01
—
89N666
BCBS
TX
Enumeration date
10/31/2005
Last updated
01/14/2014
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