Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 01050090A | IN |
N | 111NI0900X | Internist | 01050090A | IN |
N | 207RH0002X | Hospice and Palliative Medicine | 01050090A | IN |
N | 207RH0002X | Hospice and Palliative Medicine | 036.128140 | IL |
N | 207RH0002X | Hospice and Palliative Medicine | 336.089764 | IL |
Y | 207RH0002X | Hospice and Palliative Medicine | R0040 | TX |
NPI | 1396801213 |
---|---|
Provider Name | Dr. Sally Ann Kelley |
First Address | Brownsville, TX 78526-9740 |
Second Address | Brownsville, TX 78526-9740 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/12/2006 |
Last Update Date | 06/10/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200369390 | (05) | IN |
532194YMVU | WELLMED NETWORKS INC (01) | |
H57278 | (02) | IN |