Individual
LISA KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
2740 N HWY 360, GRAND PRAIRIE, TX 75050-6403
(972) 606-8300
Mailing address
925 WILDWOOD CIR, GRAPEVINE, TX 76051-6275
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA05811
TX
Other
Enumeration date
04/20/2011
Last updated
04/04/2022
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