Healthcare Provider Details

I. General information

NPI: 1669644597
Provider Name (Legal Business Name): KELLY DEAN HRANICKY LVN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/01/2008
Last Update Date: 12/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

341 S REIDEL
YORKTOWN TX
78164-2024
US

IV. Provider business mailing address

341 SOUTH RIEDEL
YORKTOWN TX
78164-2024
US

V. Phone/Fax

Practice location:
  • Phone: 361-564-4106
  • Fax: 361-564-4163
Mailing address:
  • Phone: 361-564-4106
  • Fax: 361-564-4127

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number088474
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: