Healthcare Provider Details

I. General information

NPI: 1245252493
Provider Name (Legal Business Name): THOMAS KARL KERLEY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/24/2006
Last Update Date: 02/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

602 N KEY AVE
LAMPASAS TX
76550-1106
US

IV. Provider business mailing address

602 N KEY AVE
LAMPASAS TX
76550-1106
US

V. Phone/Fax

Practice location:
  • Phone: 512-556-3682
  • Fax:
Mailing address:
  • Phone: 512-556-3682
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberJ2123
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberJ2123
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: