Healthcare Provider Details

I. General information

NPI: 1871061663
Provider Name (Legal Business Name): KELSIE FISS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2018
Last Update Date: 11/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 S COULTER ST STE 5100
AMARILLO TX
79106-1786
US

IV. Provider business mailing address

1300 S COULTER ST STE 203
AMARILLO TX
79106-1712
US

V. Phone/Fax

Practice location:
  • Phone: 806-414-9559
  • Fax: 806-351-3765
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License Number63144
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: