MEDICARE: CHRISTA KELLEY BCCS

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	174H00000X	Health Educator	BCCS25997428	TX
2	171400000X	Health & Wellness Coach	BCCS25997428	TX

General Provider Information

NPI Number	:	1346197399
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTA KELLEY BCCS

Provider Business Mailing Address
First Line	:	20711 WILDERNESS OAK STE 107
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78258-2641
Country	:	US
Telephone Number	:	210-540-0924
Fax Number	:

Provider Business Practice Location Address
First Line	:	20711 WILDERNESS OAK STE 107
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78258-2641
Country	:	US
Telephone Number	:	210-540-0924
Fax Number	:

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

Provider Enumeration Date	:	03/10/2026
Last Update Date	:	03/10/2026

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