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General NPI Number Information
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NPI Number | 1154303709
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Entity Type | Individual
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Provider Name | KELLY OFFUTT MD
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Gender | Female
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Dates
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Enumeration Date | 11/18/2005
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Last Update Date | 01/07/2021
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Provider Practice Location Address
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Address Line | 706 AVE G
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City | MARBLE FALLS
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State | TX
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Zip | 78654-5866
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Country | US
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Telephone | 830-693-8234
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Fax | 830-693-9090
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Provider Business Mailing Address
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Address Line | PO BOX 844658
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City | DALLAS
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State | TX
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Zip | 75284-4658
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Country | US
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Telephone | 254-724-8800
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | L2516
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License Number State | TX
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