Provider Demographics
NPI:1528625787
Name:JEWELL-FRANKEN, KELLY ANN
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:ANN
Last Name:JEWELL-FRANKEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9403 W FM 515
Mailing Address - Street 2:
Mailing Address - City:ALBA
Mailing Address - State:TX
Mailing Address - Zip Code:75410-2687
Mailing Address - Country:US
Mailing Address - Phone:405-215-6992
Mailing Address - Fax:
Practice Address - Street 1:9403 W FM 515
Practice Address - Street 2:
Practice Address - City:ALBA
Practice Address - State:TX
Practice Address - Zip Code:75410-2687
Practice Address - Country:US
Practice Address - Phone:405-215-6992
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-23
Last Update Date:2019-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX340606164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse