Provider Demographics
NPI:1316322423
Name:HANNA, KELLEY LYNN (FNP-C)
Entity type:Individual
Prefix:MS
First Name:KELLEY
Middle Name:LYNN
Last Name:HANNA
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:3610 ROYAL LN
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75229-5149
Mailing Address - Country:US
Mailing Address - Phone:214-293-0390
Mailing Address - Fax:
Practice Address - Street 1:1411 N BECKLEY AVE
Practice Address - Street 2:PAVILLION 3 STE 152
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75203-1259
Practice Address - Country:US
Practice Address - Phone:214-948-7700
Practice Address - Fax:214-948-7701
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-30
Last Update Date:2017-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX61113363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily