Reardon, Kellie Marie

Reardon, Kellie Marie is an individual health care provider with primary practice located at 1301 Wonder World Dr , San Marcos TX 78666-7533. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner, which is considered as her primary health care specialty. Reardon, Kellie Marie can be contacted via phone (512) 753-3796.

Contact Information

Primary practice address
1301 Wonder World Dr San Marcos TX 78666-7533
Phone: (512) 753-3796
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner 363L00000X 516912 Texas

Profile Details

NPI number 1487645404
LBN Legal business name Reardon, Kellie Marie
Credentials Family Nurse Practitioner (FNP)
Entity Individual
Sole proprietor 1 No
Enumeration date Oct 31st, 2005
Last updated Jan 14th, 2014 - about 12 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1487645404 NPPES
Texas MEDICAID 142619904
Texas Other 89N666

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