Healthcare Provider Details

I. General information

NPI: 1326905985
Provider Name (Legal Business Name): KELLEY AL-DHALAAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/06/2026
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

507 S EXCHANGE ST
WEIMAR TX
78962-2801
US

IV. Provider business mailing address

507 S EXCHANGE ST
WEIMAR TX
78962-2801
US

V. Phone/Fax

Practice location:
  • Phone: 281-682-8975
  • Fax:
Mailing address:
  • Phone: 281-682-8975
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number1090643
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: