Healthcare Provider Details

I. General information

NPI: 1922273622
Provider Name (Legal Business Name): KELLY A. NOVAK AUD, CCC/A
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2008
Last Update Date: 04/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4130 ABRAMS RD
DALLAS TX
75214-2607
US

IV. Provider business mailing address

4130 ABRAMS RD
DALLAS TX
75214-2607
US

V. Phone/Fax

Practice location:
  • Phone: 214-827-1900
  • Fax:
Mailing address:
  • Phone: 214-827-1900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number80037
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number80037
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: