Provider Demographics
NPI:1912359050
Name:KILCREASE, KELLY C (APRN)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:C
Last Name:KILCREASE
Suffix:
Gender:
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:908 LAKESIDE LN
Mailing Address - Street 2:
Mailing Address - City:KERENS
Mailing Address - State:TX
Mailing Address - Zip Code:75144-6048
Mailing Address - Country:US
Mailing Address - Phone:318-518-7967
Mailing Address - Fax:
Practice Address - Street 1:908 LAKESIDE LN
Practice Address - Street 2:
Practice Address - City:KERENS
Practice Address - State:TX
Practice Address - Zip Code:75144-6048
Practice Address - Country:US
Practice Address - Phone:318-518-7967
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-12
Last Update Date:2025-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP131121363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1265951453OtherGROUP NPI