Provider Demographics
NPI:1366760613
Name:GARRETT, KELLY JO (RPA,RA,RT(R))
Entity type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:JO
Last Name:GARRETT
Suffix:
Gender:F
Credentials:RPA,RA,RT(R)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7026 OLD KATY RD
Mailing Address - Street 2:#276
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77024-2133
Mailing Address - Country:US
Mailing Address - Phone:713-621-7436
Mailing Address - Fax:
Practice Address - Street 1:500 MEDICAL CENTER BLVD
Practice Address - Street 2:RADIOLOGY
Practice Address - City:WEBSTER
Practice Address - State:TX
Practice Address - Zip Code:77598-4220
Practice Address - Country:US
Practice Address - Phone:281-338-3831
Practice Address - Fax:281-338-3824
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-11
Last Update Date:2010-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1672243U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes243U00000XTechnologists, Technicians & Other Technical Service ProvidersRadiology Practitioner Assistant