NPIMap

Organization Active NPI

Kelsom Clinic PA

  • Family Medicine Physician
  • Irving, TX
National Provider Identifier
1104840594
Registry record updated Jan 20, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
K2252 Issued in TX
Legal business name
KELSOM CLINIC PA
Practice address
1202 W Pioneer Dr Ste 100
Irving, TX 75061-7309
Phone
(972) 254-7272
Fax
(972) 254-7575
NPI assigned
Jul 27, 2006
Last updated
Jan 20, 2026By the provider in NPPES
Organization subpart
Yes
Parent organization
KELSOM CLINIC PAAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 20, 2026

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

Authorized official

Name
Catherine Okoronkwo, MDNPI 1447343017
Title
MD
Phone
(972) 254-7272

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X K2252 TX Primary

Addresses

Primary practice location

1202 W Pioneer Dr Ste 100
Irving, TX 75061-7309

Mailing address

1202 W Pioneer Dr
Suite 100
Irving, TX 75061-7308
Phone (972) 254-7272

Other practice location 1

3220 Gus Thomasson Rd Ste 113
Suite 113
Mesquite, TX 75150-4051
Phone (972) 279-7373

Other identifiers 1

IdentifierTypeStateIssuer
160977801MedicaidTX

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050526000628 TX Part B Supplier - Clinic/Group Practice 1254391857 Receives reassigned benefits from 9 practitioners
Practice locations: Irving, TX; Mesquite, TX

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
45D0995230Kelsom Clinic Inc1202 W Pioneer Drive, # 100, Irving, TX 75061Certificate of waiverJan 13, 2028

National Provider Directory

National Provider Directory
Part of
Kelsom Clinic PA

Locations

1711 W Irving Blvd
Ste 151
Irving, TX 75061
Phone (972) 254-7272

1202 W Pioneer Dr
Ste 100
Irving, TX 75061
Phone (972) 254-7272

3220 Gus Thomasson Rd
Ste 113
Mesquite, TX 75150
Phone (972) 279-7373

Practitioners & affiliated clinicians

Practitioners 12

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1153958400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1768867200000",
    "number": "1104840594",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1202 W PIONEER DR",
            "address_2": "SUITE 100",
            "city": "IRVING",
            "state": "TX",
            "postal_code": "750617308",
            "telephone_number": "972-254-7272",
            "fax_number": "972-254-7575"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1202 W PIONEER DR STE 100",
            "city": "IRVING",
            "state": "TX",
            "postal_code": "750617309",
            "telephone_number": "972-254-7272",
            "fax_number": "972-254-7575"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3220 Gus Thomasson Rd Ste 113",
            "address_2": "SUITE 113",
            "address_purpose": "LOCATION",
            "city": "Mesquite",
            "state": "TX",
            "postal_code": "751504051",
            "country_code": "US",
            "telephone_number": "972-279-7373",
            "fax_number": "972-254-7272",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "KELSOM CLINIC PA",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "KELSOM CLINIC PA",
        "enumeration_date": "2006-07-27",
        "last_updated": "2026-01-20",
        "certification_date": "2026-01-20",
        "status": "A",
        "authorized_official_last_name": "OKORONKWO",
        "authorized_official_first_name": "CATHERINE",
        "authorized_official_title_or_position": "MD",
        "authorized_official_telephone_number": "972-254-7272",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "TX",
            "license": "K2252",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "160977801",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Irving, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 20, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.