Provider Demographics
NPI:1417068909
Name:LAWLER, KELLY R (DPM)
Entity type:Individual
Prefix:DR
First Name:KELLY
Middle Name:R
Last Name:LAWLER
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9099 CHRISTOPHER ST
Mailing Address - Street 2:
Mailing Address - City:LANTANA
Mailing Address - State:TX
Mailing Address - Zip Code:76226-6492
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2021 N MACARTHUR BLVD STE 300
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75061-2223
Practice Address - Country:US
Practice Address - Phone:972-817-1270
Practice Address - Fax:972-817-1275
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2024-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2042213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL016005246Medicaid
ILK52918Medicare PIN
IL016005246Medicaid