Individual provider Active NPI

Kathryn L Kelley, ACUTE CARE NURSE PRA

  • Acute Care Nurse Practitioner
  • Shenandoah, TX
National Provider Identifier
1205011053
Registry record updated Mar 13, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Acute Care Nurse PractitionerTaxonomy code 363LA2100X
License
AP114087 Issued in TX
Practice address
17201 I H 45 S
Shenandoah, TX 77385-3311
Phone
(936) 270-2099
NPI assigned
Dec 28, 2007
Last updated
Mar 13, 2020By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 13, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Acute Care Nurse Practitioner 363LA2100X 651221 TX
Acute Care Nurse Practitioner 363LA2100X AP114087 TX Primary

Addresses

Primary practice location

17201 I H 45 S
Shenandoah, TX 77385-3311

Mailing address

17201 I H 45 S
Shenandoah, TX 77385-3311
Phone (936) 270-2099

Other practice location 1

6411 Fannin St
Houston, TX 77030-1501
Phone (713) 704-9780

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20180423001816 TX Practitioner - Nurse Practitioner 1052674256 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
TMH Physician Associates PLLCGroup PAC ID 4486711744, 1,881 clinicians

Practice addresses (Care Compare)

16605 Southwest Fwy
Sugar Land, TX 77479-3500
Phone (281) 275-0800

16605 Southwest Fwy 400 Mob3
Methodist Family Medicine Group
Sugar Land, TX 77479-3500
Phone (281) 275-0800

16605 SW Fwy 410
Methodist Diag Card of Houston
Sugar Land, TX 77479-3500
Phone (281) 274-0148

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
651221TXMDAcute Care Nurse Practitioner
AP114087TXMDAcute Care Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
TMH Physician Associates PLLC CurrentSince Nov 18, 2019 Accepting new patients
TMH Physician Associates PLLC CurrentSince Nov 18, 2019 Accepting new patients
Houston Methodist Specialty Physicians CurrentSince Mar 1, 2026 Accepting new patients

Locations

6550 Fannin St
Ste 447
Houston, TX 77030
Phone (713) 441-0633

16605 Southwest Fwy
Ste 400
Sugar Land, TX 77479
Phone (281) 275-0800

17201 Interstate 45 S
The Woodlands, TX 77385
Phone (936) 270-2000

Interoperability endpoints

  • Direct secure messaging: kkelley306204@directhoustonmethodist.org

Organizations & group practices 3

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

NPI Registry JSON

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

{
    "created_epoch": "1198800000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1584057600000",
    "number": "1205011053",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17201 I H 45 S",
            "city": "SHENANDOAH",
            "state": "TX",
            "postal_code": "773853311",
            "telephone_number": "936-270-2099"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17201 I H 45 S",
            "city": "SHENANDOAH",
            "state": "TX",
            "postal_code": "773853311",
            "telephone_number": "936-270-2099"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6411 Fannin St",
            "address_purpose": "LOCATION",
            "city": "Houston",
            "state": "TX",
            "postal_code": "770301501",
            "country_code": "US",
            "telephone_number": "713-704-9780",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KELLEY",
        "first_name": "KATHRYN",
        "middle_name": "L",
        "credential": "ACUTE CARE NURSE PRA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-12-28",
        "last_updated": "2020-03-13",
        "certification_date": "2020-03-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "TX",
            "license": "651221",
            "primary": false
        },
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "TX",
            "license": "AP114087",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Shenandoah, TX

Sources for this page

Verify at the official NPI Registry.