Active NPI
Sarah Kelly, DDS
- Periodontics
- Fort Worth, TX
National Provider Identifier
1043862501
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Periodontics
- License
- 38236
- Practice address
- 3701 Hulen St
Fort Worth, TX 76107-6803 - Phone
- (817) 738-3510
- NPI assigned
- Jul 15, 2019
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Periodontics | 1223P0300X | PENDING | TX | |
| Periodontics | 1223P0300X | 38236 | TX | Primary |
Addresses
Primary practice location
3701 Hulen St
Fort Worth, TX 76107-6803
Mailing address
3701 Hulen St
Fort Worth, TX 76107-6803
Phone (817) 738-3510
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PENDING | TX | MD | Medical Oncology Physician |
| 38236 | TX | MD | Speech-Language Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1563148800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1658275200000",
"number": "1043862501",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3701 HULEN ST",
"city": "FORT WORTH",
"state": "TX",
"postal_code": "761076803",
"telephone_number": "817-738-3510"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3701 HULEN ST",
"city": "FORT WORTH",
"state": "TX",
"postal_code": "761076803",
"telephone_number": "817-738-3510"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KELLY",
"first_name": "SARAH",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2019-07-15",
"last_updated": "2022-07-20",
"certification_date": "2022-07-20",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0300X",
"taxonomy_group": "",
"desc": "Dentist, Periodontics",
"state": "TX",
"license": "PENDING",
"primary": false
},
{
"code": "1223P0300X",
"taxonomy_group": "",
"desc": "Dentist, Periodontics",
"state": "TX",
"license": "38236",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fort Worth, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 20, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.