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General NPI Number Information
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NPI Number | 1508813494
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Entity Type | Organization
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Legal Business Name | KELLUM MEDICAL GROUP, PA
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Dates
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Enumeration Date | 05/27/2006
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 7323 MARBACH RD STE 104
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City | SAN ANTONIO
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State | TX
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Zip | 78227-1905
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Country | US
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Telephone | 210-674-0257
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Fax | 210-369-9064
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Provider Business Mailing Address
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Address Line | 7323 MARBACH RD STE 104
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City | SAN ANTONIO
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State | TX
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Zip | 78227-1905
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Country | US
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Telephone | 210-674-0257
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Fax | 210-369-9064
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Authorized Official
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Title or Position | AO
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Name | JULIE 'KRISTI' K BRAKER
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Credential |
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Telephone | 210-231-2540
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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