Provider Demographics
NPI:1598855496
Name:GERSHON, KELLI C (MSN, APRN, BC-PCM)
Entity type:Individual
Prefix:
First Name:KELLI
Middle Name:C
Last Name:GERSHON
Suffix:
Gender:F
Credentials:MSN, APRN, BC-PCM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 COMMERCE ST STE 700
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37201-1835
Mailing Address - Country:US
Mailing Address - Phone:832-786-4970
Mailing Address - Fax:855-737-5542
Practice Address - Street 1:2425 WEST LOOP S STE 200
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77027-4208
Practice Address - Country:US
Practice Address - Phone:832-786-4970
Practice Address - Fax:855-737-5542
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2018-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX627907363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX167829401Medicaid
8B5779Medicare ID - Type Unspecified
TX167829401Medicaid