MEDICARE: JORDAN GRACE KELLY LICENSED PARAMEDIC

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	3416L0300X	Land Ambulance	780125	TX

General Provider Information

NPI Number	:	1669313185
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JORDAN GRACE KELLY LICENSED PARAMEDIC

Provider Business Mailing Address
First Line	:	1600 BIOVU DR
Second Line	:
City	:	GALVESTON
State	:	TX
Zip	:	77551-1417
Country	:	US
Telephone Number	:	409-974-1500
Fax Number	:

Provider Business Practice Location Address
First Line	:	1600 BIOVU DR
Second Line	:
City	:	GALVESTON
State	:	TX
Zip	:	77551-1417
Country	:	US
Telephone Number	:	409-974-1500
Fax Number	:

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

Provider Enumeration Date	:	04/01/2026
Last Update Date	:	04/01/2026

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Directions to “ JORDAN GRACE KELLY LICENSED PARAMEDIC” Practice Location

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