Healthcare Provider Details

I. General information

NPI: 1538525928
Provider Name (Legal Business Name): F KELLY CUNNINGHAM MD, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/14/2016
Last Update Date: 08/22/2023
Certification Date: 08/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5300 BEE CAVES RD STE 260
WEST LAKE HILLS TX
78746-5226
US

IV. Provider business mailing address

5300 BEE CAVES RD STE 260
WEST LAKE HILLS TX
78746-5226
US

V. Phone/Fax

Practice location:
  • Phone: 512-410-0767
  • Fax: 512-649-7402
Mailing address:
  • Phone: 512-410-0767
  • Fax: 512-649-7402

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number
License Number State

VIII. Authorized Official

Name: F KELLY CUNNINGHAM
Title or Position: MD/OWNER
Credential: MD
Phone: 512-410-0767