Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 688780 | TX |
NPI | 1003084567 |
---|---|
Provider Name | Kelli Chari Tyler Hayes |
First Address | Lubbock, TX 79413-6114 |
Second Address | Lubbock, TX 79413-6114 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/02/2008 |
Last Update Date | 08/04/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00395N | BC BSTX (01) | TX |
194657602 | (05) | TX |
8L1357 | (02) | TX |