Provider Demographics
NPI:1699324202
Name:DLKPAC PLLC
Entity type:Organization
Organization Name:DLKPAC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:
Authorized Official - Last Name:KELLEY
Authorized Official - Suffix:
Authorized Official - Credentials:PAC
Authorized Official - Phone:903-778-2942
Mailing Address - Street 1:245 LAKEVIEW DR
Mailing Address - Street 2:
Mailing Address - City:TRINIDAD
Mailing Address - State:TX
Mailing Address - Zip Code:75163-2213
Mailing Address - Country:US
Mailing Address - Phone:414-207-3506
Mailing Address - Fax:
Practice Address - Street 1:218 PARK ST
Practice Address - Street 2:
Practice Address - City:TRINIDAD
Practice Address - State:TX
Practice Address - Zip Code:75163-6060
Practice Address - Country:US
Practice Address - Phone:903-778-2942
Practice Address - Fax:903-778-2177
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-06
Last Update Date:2019-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty