Healthcare Provider Details

I. General information

NPI: 1457514846
Provider Name (Legal Business Name): JAMES KELLY TROY RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2008
Last Update Date: 07/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4500 S LANCASTER RD
DALLAS TX
75216-7167
US

IV. Provider business mailing address

4500 S LANCASTER RD
DALLAS TX
75216-7167
US

V. Phone/Fax

Practice location:
  • Phone: 214-857-1748
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number123089
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: