MEDICARE: KELLEY LOUISE LARDY FNP

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	363LF0000X	Family Nurse Practitioner	714766	TX
2	363LF0000X	Family Nurse Practitioner	469271	CA

General Provider Information

NPI Number	:	1124269899
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLEY LOUISE LARDY FNP

Provider Business Mailing Address
First Line	:	8787 SIENNA SPRINGS BLVD APT 118
Second Line	:
City	:	MISSOURI CITY
State	:	TX
Zip	:	77459-6065
Country	:	US
Telephone Number	:	281-813-6137
Fax Number	:

Provider Business Practice Location Address
First Line	:	8787 SIENNA SPRINGS BLVD APT 118
Second Line	:
City	:	MISSOURI CITY
State	:	TX
Zip	:	77459-6065
Country	:	US
Telephone Number	:	281-813-6137
Fax Number	:

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

Provider Enumeration Date	:	03/10/2009
Last Update Date	:	03/11/2009

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