MEDICARE: KELLY M EIFLING AG-ACNP

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	363LG0600X	Gerontology Nurse Practitioner	849895	TX
2	363L00000X	Nurse Practitioner	1571190	ID
3	363LA2100X	Acute Care Nurse Practitioner	849895	TX

General Provider Information

NPI Number	:	1083371728
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLY M EIFLING AG-ACNP

Provider Business Mailing Address
First Line	:	4375 BOOTH CALLOWAY RD STE 400
Second Line	:
City	:	NORTH RICHLAND HILLS
State	:	TX
Zip	:	76180-8365
Country	:	US
Telephone Number	:	817-284-3915
Fax Number	:	844-289-7694

Provider Business Practice Location Address
First Line	:	4375 BOOTH CALLOWAY RD STE 400
Second Line	:
City	:	NORTH RICHLAND HILLS
State	:	TX
Zip	:	76180-8365
Country	:	US
Telephone Number	:	817-284-3915
Fax Number	:	844-289-7694

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

Provider Enumeration Date	:	11/17/2021
Last Update Date	:	06/02/2026

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