Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | M1921 | TX |
N | 111NI0900X | Internist | M1921 | TX |
Y | 207RP1001X | Pulmonary Disease | M1921 | TX |
NPI | 1053344887 |
---|---|
Provider Name | Brandy J Mckelvy |
First Address | Dallas, TX 75303-1173 |
Second Address | Houston, TX 77030-3000 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/07/2006 |
Last Update Date | 15/08/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
176052201 | (05) | TX |
176052202 | (05) | TX |
8F8256 | BCBS (01) | TX |
I37629 | (02) | TX |