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General NPI Number Information
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NPI Number | 1326315359
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Entity Type | Individual
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Provider Name | KRISTIE KELLEY R.T.
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Gender | Female
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Dates
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Enumeration Date | 11/18/2011
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Last Update Date | 11/18/2011
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Provider Practice Location Address
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Address Line | 3820 POINTE PKWY 3820 POINTE PARKWAY AT FOLSOM DRIVE, ONE FOLSOM
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City | BEAUMONT
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State | TX
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Zip | 77706-2000
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Country | US
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Telephone | 409-767-8221
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Fax |
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Provider Business Mailing Address
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Address Line | 3820 POINTE PKWY 3820 POINTE PARKWAY AT FOLSOM DRIVE, ONE FOLSOM
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City | BEAUMONT
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State | TX
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Zip | 77706-2000
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Country | US
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Telephone | 409-767-8221
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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 | 247100000X
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Taxonomy Name | Radiologic Technologist
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License Number | 15935
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 2471M1202X
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Taxonomy Name | Magnetic Resonance Imaging Radiologic Technologist
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License Number | 225579
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License Number State | TX
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