MEDICARE: MS. LASHONDA KELLY CRNA, FNP-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	AP143840	TX
2	363LF0000X	Family Nurse Practitioner	901758	MS
3	367500000X	Certified Registered Nurse Anesthetist	AP143840	TX

General Provider Information

NPI Number	:	1295277523
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LASHONDA KELLY CRNA, FNP-C

Provider Business Mailing Address
First Line	:	6720 BERTNER AVE
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77030
Country	:	US
Telephone Number	:	832-355-2666
Fax Number	:

Provider Business Practice Location Address
First Line	:	6606 LBJ FWY STE 200
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75240-6524
Country	:	US
Telephone Number	:	972-233-1999
Fax Number	:

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

Provider Enumeration Date	:	11/17/2016
Last Update Date	:	10/17/2022

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