Healthcare Provider Details

I. General information

NPI: 1285552968
Provider Name (Legal Business Name): DR. AMANDA LEAH KELLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2026
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6001 KYLE PKWY
KYLE TX
78640-6112
US

IV. Provider business mailing address

6001 KYLE PKWY
KYLE TX
78640-6112
US

V. Phone/Fax

Practice location:
  • Phone: 512-504-5170
  • Fax:
Mailing address:
  • Phone: 512-504-5170
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number46230
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: