Healthcare Provider Details

I. General information

NPI: 1750640892
Provider Name (Legal Business Name): ANGELA SIMMEN KELLEY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2012
Last Update Date: 03/20/2025
Certification Date: 03/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

911 W 38TH ST STE 402
AUSTIN TX
78705-1122
US

IV. Provider business mailing address

PO BOX 4346, DEPT 5044
HOUSTON TX
77210
US

V. Phone/Fax

Practice location:
  • Phone: 512-479-7979
  • Fax: 512-479-7985
Mailing address:
  • Phone: 713-300-1123
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number4301100444
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License NumberS2080
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: