MEDICARE: SHELBY KYSAR M.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174N00000X	Lactation Consultant (Non-RN)	361532
2	235Z00000X	Speech-Language Pathologist	119107	TX

General Provider Information

NPI Number	:	1083286421
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHELBY KYSAR M.A.

Provider Business Mailing Address
First Line	:	252 S ELM ST STE A
Second Line	:
City	:	KELLER
State	:	TX
Zip	:	76248-2258
Country	:	US
Telephone Number	:	817-381-8272
Fax Number	:

Provider Business Practice Location Address
First Line	:	252 S ELM ST STE A
Second Line	:
City	:	KELLER
State	:	TX
Zip	:	76248-2258
Country	:	US
Telephone Number	:	817-381-8272
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/14/2021
Last Update Date	:	02/09/2026

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Directions to “ SHELBY KYSAR M.A.” Practice Location

Language	Start Address	Practice Location

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