Individual
KELLY JANISH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
6101 WOODWAY DR, SUITE 230, WOODWAY, TX 76712-6111
(254) 537-6400
(254) 537-6401
Mailing address
PO BOX 18962, BELFAST, ME 04915-4084
(800) 566-5050
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
P0235
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00N59X
BCBS
TX
01
—
084249401
GROUP MEDICAID
TX
01
—
1932210838
GROUP TPI
TX
05
—
285536301
—
TX
Enumeration date
07/09/2008
Last updated
01/24/2017
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