MEDICARE: MYRA EUGENIA KELLEY-MOTA LVN

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	164X00000X	Licensed Vocational Nurse	329342	TX

General Provider Information

NPI Number	:	1639069156
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MYRA EUGENIA KELLEY-MOTA LVN

Provider Business Mailing Address
First Line	:	7236 ROYAL ARMS DR APT A
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79912-1537
Country	:	US
Telephone Number	:	915-471-9201
Fax Number	:

Provider Business Practice Location Address
First Line	:	7236 ROYAL ARMS DR APT A
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79912-1537
Country	:	US
Telephone Number	:	915-471-9201
Fax Number	:	915-471-9201

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

Provider Enumeration Date	:	07/07/2025
Last Update Date	:	07/07/2025

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