Provider Demographics
NPI:1891048229
Name:QUINN, KELLY MARIE (ACNP)
Entity type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:MARIE
Last Name:QUINN
Suffix:
Gender:
Credentials:ACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7450 REMCON CIR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912-3508
Mailing Address - Country:US
Mailing Address - Phone:915-532-6767
Mailing Address - Fax:915-532-4023
Practice Address - Street 1:7450 REMCON CIR
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79912-3508
Practice Address - Country:US
Practice Address - Phone:915-532-6767
Practice Address - Fax:915-532-4023
Is Sole Proprietor?:No
Enumeration Date:2012-10-23
Last Update Date:2025-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX736649363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB166635Medicare PIN