Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LA2100X | Nurse Practitioner - Acute Care | 849895 | TX |
Y | 363LG0600X | Nurse Practitioner - Gerontology | 849895 | TX |
NPI | 1083371728 |
---|---|
Provider Name | Kelly M Glowicz |
First Address | Bedford, TX 76021-6604 |
Second Address | Bedford, TX 76021-6604 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/11/2021 |
Last Update Date | 17/11/2021 |