NPIMap

Individual provider Active NPI

Kellie Lyn Flaherty, PA

  • Physician Assistant
  • Texarkana, TX
National Provider Identifier
1265988208
Registry record updated Aug 30, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
2604 Saint Michael Dr
Suite 340
Texarkana, TX 75503-2379
Phone
(903) 614-5111
NPI assigned
Aug 30, 2016
Last updated
Aug 30, 2016By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 30, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X Primary

Addresses

Primary practice location

2604 Saint Michael Dr
Suite 340
Texarkana, TX 75503-2379

Mailing address

2604 Saint Michael Dr
Suite 340
Texarkana, TX 75503-2379

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX, VT2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20170424000969 TX Practitioner - Physician Assistant 6709162928 Reassigns benefits to 9 organizations
I20250908002015 VT Practitioner - Physician Assistant 6709162928 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Southeast Texas Intensivists, PLLCGroup PAC ID 7810342672, 37 clinicians
Jefferson Emergency Physicians PLLCGroup PAC ID 4880048560, 94 clinicians
Gulf Coast Intensivists, PLLCGroup PAC ID 2264896364, 39 clinicians

Practice addresses (Care Compare)

2600 Saint Michael Dr
Texarkana, TX 75503-2372
Phone (903) 614-1000

2830 Calder St
Beaumont, TX 77702-1809
Phone (409) 892-7171

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Gulf Coast Intensivists, PLLC Physician Assistant CurrentSince Apr 1, 2026 Accepting new patients

Locations

2830 Calder St
Fl 4
Beaumont, TX 77702
Phone (409) 899-5156

5950 Saratoga Blvd
Corpus Christi, TX 78414
Phone (361) 985-5000

600 Elizabeth St
Corpus Christi, TX 78404
Phone (361) 325-2511

Organizations & group practices 10

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.

Hospital & facility affiliations 6

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1472515200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1472515200000",
    "number": "1265988208",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2604 SAINT MICHAEL DR",
            "address_2": "SUITE 340",
            "city": "TEXARKANA",
            "state": "TX",
            "postal_code": "755032379"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2604 SAINT MICHAEL DR",
            "address_2": "SUITE 340",
            "city": "TEXARKANA",
            "state": "TX",
            "postal_code": "755032379",
            "telephone_number": "903-614-5111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FLAHERTY",
        "first_name": "KELLIE",
        "middle_name": "LYN",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-08-30",
        "last_updated": "2016-08-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Texarkana, TX

Sources for this page

Verify at the official NPI Registry.