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NPI Code Detail

MEDICARE: KELSEY JEWEL PHENICE

MEDICARE: KELSEY JEWEL PHENICE
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
1163WC0200XCritical Care Medicine Registered Nurse1037981TX

General Provider Information

NPI Number : 1386596625
Entity Type Code : Individual
Provider Name (Legal Business Name) : KELSEY JEWEL PHENICE
Provider Business Mailing Address
First Line : 1699 HERMANN DR
Second Line :
City : HOUSTON
State : TX
Zip : 77004-7255
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 4502 MEDICAL DR
Second Line :
City : SAN ANTONIO
State : TX
Zip : 78229-4402
Country : US
Telephone Number : 210-358-4000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/10/2026
Last Update Date : 02/10/2026

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Directions to “ KELSEY JEWEL PHENICE ” Practice Location

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