MEDICARE: KELLY MARGARET WEBB PAC

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	363A00000X	Physician Assistant	PA03019	TX

General Provider Information

NPI Number	:	1538157391
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLY MARGARET WEBB PAC

Provider Business Mailing Address
First Line	:	5310 HARVEST HILL RD STE 290
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75230-5826
Country	:	US
Telephone Number	:	214-420-0650
Fax Number	:	903-939-0755

Provider Business Practice Location Address
First Line	:	601 AIRPORT RD STE 140
Second Line	:
City	:	SULPHUR SPRINGS
State	:	TX
Zip	:	75482-2009
Country	:	US
Telephone Number	:	903-582-4424
Fax Number	:	903-582-4423

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

Provider Enumeration Date	:	10/06/2005
Last Update Date	:	10/06/2023

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