Traci Kelly, M.ED, BCBA

Primary specialty

Behavior AnalystTaxonomy code 103K00000X

License

1-21-47100 Issued in TX

Practice address

9636 Lea Shore St
Fort Worth, TX 76179-3225

Phone

(817) 682-0163

NPI assigned

Jan 19, 2021

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Ms. Traci Ann Kelly Other name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Education

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Giggles Therapy LLC

  • Social Worker
  • River Oaks, TX
  • NPI 1578969937

  Behavior Analyst

  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1611014400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1611014400000",
    "number": "1003406554",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9636 LEA SHORE ST",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761793225",
            "telephone_number": "817-682-0163"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9636 LEA SHORE ST",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761793225",
            "telephone_number": "817-682-0163"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLY",
        "first_name": "TRACI",
        "credential": "M.ED, BCBA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-01-19",
        "last_updated": "2021-01-19",
        "certification_date": "2021-01-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": "TX",
            "license": "1-21-47100",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "TRACI",
            "last_name": "KELLY",
            "middle_name": "ANN",
            "prefix": "MS.",
            "credential": "M.ED, BCBA",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Marie T Kelly, M.D.
• Miranda Kelly
• Robert Hart Kelly, MD
• Sarah Kelly, DDS
• Sarah Kelly, M.S., CCC/SLP
• Tracy Kelly, BCBA
• Tricia Kelly, NURSE PRACTITIONER
• Cara Kelso, M.A., BCBA
• Amanda M. Kemp, LCDC
• Andrew P Kemp, OD

• Behavior Analyst in Fort Worth, TX
• Providers in Fort Worth, TX by specialty
• Behavior Analyst in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 19, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.