Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 2007011381 | MO |
Y | 208600000X | Surgeon | 2007011381 | MO |
N | 208200000X | Surgeon | 75893 | GA |
N | 208600000X | Surgeon | 75893 | GA |
N | 2086S0122X | Plastic and Reconstructive Surgery | 2007011381 | MO |
NPI | 1275748220 |
---|---|
Provider Name | Kelly Ellen Kafka |
First Address | Fort Sam Houston, TX 78234-4504 |
Second Address | Ft. Sam Houston, TX 78234 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/05/2007 |
Last Update Date | 09/10/2019 |