MEDICARE: KELLY LABADIE ZENTMEYER P.A.-C

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	PA07153	TX

General Provider Information

NPI Number	:	1801194634
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLY LABADIE ZENTMEYER P.A.-C

Provider Business Mailing Address
First Line	:	2420 CLARK ST APT 717
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75204-2409
Country	:	US
Telephone Number	:	512-680-0428
Fax Number	:

Provider Business Practice Location Address
First Line	:	6120 E MOCKINGBIRD LN
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75214-2601
Country	:	US
Telephone Number	:	512-680-0428
Fax Number	:

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

Provider Enumeration Date	:	03/02/2011
Last Update Date	:	05/23/2014

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