Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363L00000X | Nurse Practitioner | 518078 | TX |
Y | 363LA2100X | Nurse Practitioner - Acute Care | 518078 | TX |
N | 363LC0200X | Nurse Practitioner - Critical Care Medicine | 518078 | TX |
NPI | 1558357632 |
---|---|
Provider Name | Kelli Yvette Thurman |
First Address | Bedford, TX 76022-6913 |
Second Address | Bedford, TX 76022-6913 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/09/2005 |
Last Update Date | 27/03/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
041504401 | (05) | TX |
S81325 | (02) | TX |