Provider Demographics
NPI:1972525376
Name:ALBERDA, KELLY (MD)
Entity type:Individual
Prefix:DR
First Name:KELLY
Middle Name:
Last Name:ALBERDA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5222 BURNET RD STE 200
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78756-2433
Mailing Address - Country:US
Mailing Address - Phone:512-459-9889
Mailing Address - Fax:512-389-2935
Practice Address - Street 1:5222 BURNET RD STE 200
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78756-2433
Practice Address - Country:US
Practice Address - Phone:512-459-9889
Practice Address - Fax:512-389-2935
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2024-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL9995207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX172293604Medicaid
TX172293601Medicaid
TX172293601Medicaid
TX172293604Medicaid