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NPI Code Detail

MEDICARE: MRS. KRISTA LANAE KELLAR FNP

MEDICARE: MRS. KRISTA LANAE KELLAR FNP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse Practitioner703932TX

General Provider Information

NPI Number : 1245420322
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. KRISTA LANAE KELLAR FNP
Provider Business Mailing Address
First Line : PO BOX 844658
Second Line :
City : DALLAS
State : TX
Zip : 75284-4658
Country : US
Telephone Number : 800-994-0371
Fax Number :
Provider Business Practice Location Address
First Line : 546 N KEGLEY RD
Second Line :
City : TEMPLE
State : TX
Zip : 76502-4069
Country : US
Telephone Number : 254-215-0900
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/26/2007
Last Update Date : 03/17/2018

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