Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | S6139 | TX |
NPI | 1023428802 |
---|---|
Provider Name | Kelly Bree |
First Address | Houston, TX 77210-4439 |
Second Address | Houston, TX 77030-4000 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/05/2014 |
Last Update Date | 12/07/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
415963401 | (05) | TX |
415963402 | MEDICAID CSHCN (01) | TX |
8NJ637 | BCBS (01) | TX |
Q00076452 | RR MEDICARE (01) | TX |