MEDICARE: DR. SALLY ANN KELLEY MD

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	207RH0002X	Hospice and Palliative Medicine (Internal Medicine) Physician	R0040	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	532194YMVU	OTHER		WELLMED NETWORKS INC

General Provider Information

NPI Number	:	1396801213
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SALLY ANN KELLEY MD

Provider Business Mailing Address
First Line	:	3809 W BUSINESS 83
Second Line	:
City	:	HARLINGEN
State	:	TX
Zip	:	78552-3521
Country	:	US
Telephone Number	:	956-504-3550
Fax Number	:	956-734-9038

Provider Business Practice Location Address
First Line	:	3809 W BUSINESS 83
Second Line	:
City	:	HARLINGEN
State	:	TX
Zip	:	78552-3521
Country	:	US
Telephone Number	:	956-504-3550
Fax Number	:	956-734-9038

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

Provider Enumeration Date	:	12/28/2006
Last Update Date	:	10/09/2023

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