Individual
KELLY KULLENBERG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LVN
Contact information
Practice address
3508 FAR WEST BLVD, AUSTIN, TX 78731-3080
(512) 828-3990
Mailing address
1812 PASEO VERDE DR, LEANDER, TX 78641-8293
(512) 426-3515
Taxonomy
Speciality
Code
Description
License number
State
164X00000X
Licensed Vocational Nurse
Primary
149133
TX
Other
Enumeration date
08/31/2018
Last updated
08/31/2018
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