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General NPI Number Information
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NPI Number | 1891908547
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Entity Type | Individual
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Provider Name | KELLY WYLIE D.O.M.
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Gender | Female
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Dates
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Enumeration Date | 05/08/2007
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Last Update Date | 06/06/2025
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Provider Practice Location Address
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Address Line | 6730 ATASCOCITA RD STE 108
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City | HUMBLE
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State | TX
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Zip | 77346-1995
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Country | US
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Telephone | 281-466-8494
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Fax |
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Provider Business Mailing Address
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Address Line | 2522 TWISTING PINE CT
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City | KINGWOOD
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State | TX
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Zip | 77345-2350
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Country | US
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Telephone | 915-373-1107
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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 | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | AC00461
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License Number State | TX
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