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NPI Code Detail

MEDICARE: DR. JOSEPHINE T KELEBENG

MEDICARE: DR. JOSEPHINE T KELEBENG
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
1183500000XPharmacist46800TX

General Provider Information

NPI Number : 1467780486
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JOSEPHINE T KELEBENG
Provider Business Mailing Address
First Line : 10340 SIXPENCE LN
Second Line :
City : FORT WORTH
State : TX
Zip : 76108-6991
Country : US
Telephone Number : 817-304-4341
Fax Number :
Provider Business Practice Location Address
First Line : 9625 WHITE SETTLEMENT RD
Second Line :
City : FORT WORTH
State : TX
Zip : 76108-4406
Country : US
Telephone Number : 817-367-3469
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/02/2009
Last Update Date : 12/02/2009

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Directions to “ DR. JOSEPHINE T KELEBENG ” Practice Location

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