Healthcare Provider Details

I. General information

NPI: 1134808371
Provider Name (Legal Business Name): KELLY NOWICKI RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KELLY NOWICKI RN

II. Dates (important events)

Enumeration Date: 07/14/2023
Last Update Date: 03/06/2025
Certification Date: 03/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 FONDREN RD STE 300
HOUSTON TX
77063-2313
US

IV. Provider business mailing address

PO BOX 631607
CINCINNATI OH
45263-1607
US

V. Phone/Fax

Practice location:
  • Phone: 713-730-2229
  • Fax: 713-334-5547
Mailing address:
  • Phone: 713-300-1123
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1141978
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: