Provider Demographics
NPI:1194563593
Name:CORRE, KELLY JOY (LVN)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:JOY
Last Name:CORRE
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:JOY
Other - Last Name:BEENE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LVN
Mailing Address - Street 1:925 S PADRE ISLAND DR
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78416-2347
Mailing Address - Country:US
Mailing Address - Phone:361-851-6900
Mailing Address - Fax:
Practice Address - Street 1:925 S PADRE ISLAND DR
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78416-2347
Practice Address - Country:US
Practice Address - Phone:361-851-6900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-18
Last Update Date:2024-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX323836164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse