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General NPI Number Information
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NPI Number | 1992014971
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Entity Type | Individual
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Provider Name | MS. KELLY MICHELLE ELLIS
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Gender | Female
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Dates
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Enumeration Date | 09/24/2010
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Last Update Date | 09/24/2010
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Provider Practice Location Address
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Address Line | 4230 TREE MOSS PL
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City | HUMBLE
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State | TX
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Zip | 77346-4560
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Country | US
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Telephone | 281-454-4497
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Fax |
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Provider Business Mailing Address
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Address Line | 2407 PERRY ST
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City | BAYTOWN
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State | TX
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Zip | 77521-1074
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Country | US
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Telephone | 281-896-1198
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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 | 246RP1900X
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Taxonomy Name | Phlebotomy Technician
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License Number | CPT14091
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 246Z00000X
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Taxonomy Name | Other Specialist/Technologist
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License Number | CERTIFIED BIOTECH
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License Number State | CA
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