MEDICARE: MRS. KELLY MICHOLE ANGLIN-POINDEXTER NP-C

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
1	363LF0000X	Family Nurse Practitioner	AP125478	TX

General Provider Information

NPI Number	:	1275511537
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KELLY MICHOLE ANGLIN-POINDEXTER NP-C

Provider Business Mailing Address
First Line	:	1500 MAIN ST
Second Line	:
City	:	SOUTH HOUSTON
State	:	TX
Zip	:	77587-4252
Country	:	US
Telephone Number	:	713-946-7461
Fax Number	:	713-946-7426

Provider Business Practice Location Address
First Line	:	1500 MAIN ST
Second Line	:
City	:	SOUTH HOUSTON
State	:	TX
Zip	:	77587-4252
Country	:	US
Telephone Number	:	713-946-7461
Fax Number	:	713-946-7426

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/06/2006
Last Update Date	:	01/05/2022

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