Healthcare Provider Details

I. General information

NPI: 1366930174
Provider Name (Legal Business Name): KELLI RICH NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2018
Last Update Date: 09/18/2022
Certification Date: 09/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4421 HIGHWAY 6 S STE 100
COLLEGE STATION TX
77845-6176
US

IV. Provider business mailing address

4401 HIGHWAY 6 S
COLLEGE STATION TX
77845-4428
US

V. Phone/Fax

Practice location:
  • Phone: 979-731-5200
  • Fax: 979-731-5210
Mailing address:
  • Phone: 979-324-4172
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP137168
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: