Healthcare Provider Details

I. General information

NPI: 1326432295
Provider Name (Legal Business Name): KELLY R. WILL, M.D., P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2015
Last Update Date: 10/22/2025
Certification Date: 10/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1351 W PRESIDENT GEORGE BUSH HWY
RICHARDSON TX
75080-1133
US

IV. Provider business mailing address

4650 COLE AVE APT 101
DALLAS TX
75205-4085
US

V. Phone/Fax

Practice location:
  • Phone: 972-777-6101
  • Fax: 972-833-2005
Mailing address:
  • Phone: 214-507-0188
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number StateTX

VIII. Authorized Official

Name: DR. KELLY R WILL
Title or Position: OWNER
Credential: M.D.
Phone: 972-777-6101