Healthcare Provider Details

I. General information

NPI: 1548545643
Provider Name (Legal Business Name): KELLY A KACZOROWSKI ACNS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/20/2011
Last Update Date: 10/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

929 GESSNER RD STE 2410
HOUSTON TX
77024-2515
US

IV. Provider business mailing address

6400 FANNIN ST STE 2510
HOUSTON TX
77030-1521
US

V. Phone/Fax

Practice location:
  • Phone: 713-242-4410
  • Fax: 713-242-4412
Mailing address:
  • Phone: 713-704-6772
  • Fax: 713-704-1796

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SA2200X
TaxonomyAdult Health Clinical Nurse Specialist
License Number730700
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: