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General NPI Number Information
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NPI Number | 1114427309
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Entity Type | Individual
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Provider Name | KELLY MICHELLE MARTINEZ PMHNP-BC
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Gender | Female
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Dates
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Enumeration Date | 02/14/2018
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Last Update Date | 08/31/2020
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Provider Practice Location Address
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Address Line | 2006 BROADWAY ST STE 101
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City | PEARLAND
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State | TX
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Zip | 77581-5559
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Country | US
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Telephone | 832-779-8521
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Fax |
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Provider Business Mailing Address
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Address Line | 2906 CONCORD KNOLL DR
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City | PEARLAND
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State | TX
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Zip | 77581-4791
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Country | US
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Telephone | 832-233-0464
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Fax |
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | AP136617
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License Number State | TX
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