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General NPI Number Information
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NPI Number | 1063873602
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Entity Type | Individual
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Provider Name | KELLEY K. MENEFEE PA
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Gender | Female
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Dates
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Enumeration Date | 03/10/2016
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Last Update Date | 05/29/2020
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Provider Practice Location Address
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Address Line | 1651 W ROSEDALE ST STE 100
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City | FORT WORTH
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State | TX
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Zip | 76104-7437
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Country | US
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Telephone | 817-930-2030
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Fax | 817-930-2031
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Provider Business Mailing Address
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Address Line | P.O. BOX 961205
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City | FORT WORTH
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State | TX
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Zip | 76161-1205
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Country | US
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Telephone | 817-740-8400
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Fax | 817-378-3699
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA10483
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License Number State | TX
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