Provider Demographics
NPI:1487876264
Name:KELLEY, KELLY D (ACA, NBC-HIS)
Entity type:Individual
Prefix:MR
First Name:KELLY
Middle Name:D
Last Name:KELLEY
Suffix:
Gender:M
Credentials:ACA, NBC-HIS
Other - Prefix:
Other - First Name:HEARING
Other - Middle Name:
Other - Last Name:RESEARCH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:3320 PECAN VALLEY DR
Mailing Address - Street 2:SUITE E.
Mailing Address - City:TEMPLE
Mailing Address - State:TX
Mailing Address - Zip Code:76502-1569
Mailing Address - Country:US
Mailing Address - Phone:254-742-0580
Mailing Address - Fax:254-742-0967
Practice Address - Street 1:3320 PECAN VALLEY DR
Practice Address - Street 2:SUITE E.
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76502-1569
Practice Address - Country:US
Practice Address - Phone:254-742-0580
Practice Address - Fax:254-742-0967
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXTX50601237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist