Kelly's Primary Care, Inc

Primary specialty

Preferred Provider OrganizationTaxonomy code 305R00000X

License

006524 Issued in TX

Legal business name

KELLY'S PRIMARY CARE, INC

Practice address

2009 N Conway Ave
Mission, TX 78572-2965

Phone

(956) 583-0141

Fax

(956) 583-0143

NPI assigned

Feb 22, 2007

Last updated

Jun 7, 2011By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Jaynie Chapa, RN

Title

Administrator

Phone

(956) 583-0141

Specialties & licenses 1

Addresses

Other identifiers 3

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

{
    "created_epoch": "1172102400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1307404800000",
    "number": "1083749824",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2007 N CONWAY AVE",
            "city": "MISSION",
            "state": "TX",
            "postal_code": "78572",
            "telephone_number": "956-583-0141",
            "fax_number": "956-583-0143"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2009 N CONWAY AVE",
            "city": "MISSION",
            "state": "TX",
            "postal_code": "785722965",
            "telephone_number": "956-583-0141",
            "fax_number": "956-583-0143"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KELLY'S PRIMARY CARE, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-22",
        "last_updated": "2011-06-07",
        "status": "A",
        "authorized_official_last_name": "CHAPA",
        "authorized_official_first_name": "JAYNIE",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "956-583-0141",
        "authorized_official_credential": "RN"
    },
    "taxonomies": [
        {
            "code": "305R00000X",
            "taxonomy_group": "",
            "desc": "Preferred Provider Organization",
            "state": "TX",
            "license": "006524",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001012821",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "185365701",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000017300",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Andre Dean Kaufman
• Jaspreet Kaur, M.D.
• KCCL LLC
• Kaylee Cassandra Kelley
• Kelly's D.M.E., Inc.
• Kellys Health Care Inc
• Kesturkoppal Maralidhara, M.D., P.a.
• Khit and Associates, PLLC (Khit Chiropractic and Wellness Center)
• Alejandra G. Khit, D.C.
• Amjad Khuffash, DMD

• Preferred Provider Organization in Mission, TX
• Providers in Mission, TX by specialty
• Preferred Provider Organization in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 7, 2011; 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.