MEDICARE: KELLIE BEHAN

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	363A00000X	Physician Assistant		TX

General Provider Information

NPI Number	:	1194106070
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLIE BEHAN

Provider Business Mailing Address
First Line	:	4401 COIT RD
Second Line	:	#305
City	:	FRISCO
State	:	TX
Zip	:	75035-0500
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1 CHISHOLM TRAIL RD STE 5200
Second Line	:
City	:	ROUND ROCK
State	:	TX
Zip	:	78681-5090
Country	:	US
Telephone Number	:	972-697-3945
Fax Number	:

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

Provider Enumeration Date	:	06/16/2015
Last Update Date	:	08/30/2023

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Directions to “ KELLIE BEHAN ” Practice Location

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