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General NPI Number Information
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NPI Number | 1124386941
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Entity Type | Organization
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Legal Business Name | KELLY J FOX LLC
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Dates
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Enumeration Date | 04/30/2012
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Last Update Date | 04/30/2012
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Provider Practice Location Address
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Address Line | 2412 OLD NORTH RD SUITE 100B
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City | DENTON
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State | TX
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Zip | 76209-1548
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Country | US
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Telephone | 940-387-5800
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Fax | 940-387-5806
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Provider Business Mailing Address
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Address Line | 2412 OLD NORTH RD SUITE 100B
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City | DENTON
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State | TX
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Zip | 76209-1548
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Country | US
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Telephone | 940-387-5800
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Fax | 940-387-5806
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Authorized Official
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Title or Position | FNP/ OWNER
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Name | KELLY FOX
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Credential | FNP
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Telephone | 940-387-5800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 582397
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License Number State | TX
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