MEDICARE: KYNDYL A. KELLEY

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	183700000X	Pharmacy Technician

General Provider Information

NPI Number	:	1942890777
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KYNDYL A. KELLEY

Provider Business Mailing Address
First Line	:	118 JOHNSON ST
Second Line	:
City	:	LA MARQUE
State	:	TX
Zip	:	77568-3306
Country	:	US
Telephone Number	:	409-996-1312
Fax Number	:

Provider Business Practice Location Address
First Line	:	3502 PALMER HWY
Second Line	:
City	:	TEXAS CITY
State	:	TX
Zip	:	77590-6514
Country	:	US
Telephone Number	:	409-943-4249
Fax Number	:

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

Provider Enumeration Date	:	01/25/2021
Last Update Date	:	01/25/2021

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Directions to “ KYNDYL A. KELLEY ” Practice Location

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