Whitehead, Kelli D

Whitehead, Kelli D is an individual health care provider with primary practice located at 2004 N Goliad St , Rockwall TX 75087-7317. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Family, which is considered as her primary health care specialty. Whitehead, Kelli D can be contacted via phone (972) 722-4706.

Contact Information

Primary practice address
2004 N Goliad St Rockwall TX 75087-7317
Phone: (972) 722-4706
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Family 363LF0000X AP113566 Texas

Profile Details

NPI number 1619069184
LBN Legal business name Whitehead, Kelli D
Credentials Nurse Practitioner (NP)
Entity Individual
Sole proprietor 1 No
Enumeration date Sep 29th, 2006
Last updated Oct 6th, 2015 - about 9 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1619069184 NPPES
Texas MEDICAID 168800404
Texas MEDICAID 168800403

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