Richard Dwain Kelley, MD

Primary specialty

Emergency Medicine PhysicianTaxonomy code 207P00000X

License

L6457 Issued in TX

Practice address

13435 N Hwy 183 Ste 311
Austin, TX 78750-3258

Phone

(512) 614-1200

NPI assigned

Jul 24, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Richard Dwain Kelley Other name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

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

• Freestone Emergency Medicine Associates PA

  • Nurse Practitioner
  • Fairfield, TX
  • NPI 1124057849

  Emergency Medicine

  NPD (past)

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

{
    "created_epoch": "1153699200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1492992000000",
    "number": "1376565820",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3401 ALDWYCHE DR",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787045913",
            "telephone_number": "512-569-4457"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13435 N HWY 183 STE 311",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787503258",
            "telephone_number": "512-614-1200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLEY",
        "first_name": "RICHARD",
        "middle_name": "DWAIN",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-24",
        "last_updated": "2017-04-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "TX",
            "license": "L6457",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "160443101",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "RICHARD",
            "last_name": "KELLEY",
            "middle_name": "DWAIN",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Janelle Kelley
• John Christopher Kelley, M.S.
• Michelle Ann Kelley, M.ED.,RBT
• Patrick Kelley, M.D.
• Rachel Michelle Kelley, LPC
• Tia Kelley, MA
• Bethany Kelliher, CRNA
• Byron K. Kelln, DDS
• Elizabeth Ann Kellso
• Kelly Campbell, MD, PLLC

• Emergency Medicine Physician in Austin, TX
• Providers in Austin, TX by specialty
• Emergency Medicine Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 24, 2017; 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.