Active NPI
Kelly Marie Ebner, FNP
- Family Nurse Practitioner
- Spring, TX
National Provider Identifier
1376985440
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- 758196
- Practice address
- 25410 Interstate 45
Spring, TX 77386-1351 - Phone
- (281) 367-1414
- Fax
- (281) 363-5686
- NPI assigned
- Jul 18, 2013
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 758196 | TX | Primary |
| Nurse Practitioner | 363L00000X | 758196 | TX |
Addresses
Primary practice location
25410 Interstate 45
Spring, TX 77386-1351
Mailing address
25410 Interstate 45
Spring, TX 77386-1351
Phone (281) 367-1414
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 758196 | TX | MD | Family Nurse Practitioner |
Interoperability endpoints
- kelly.ebner.1@30127.direct.athenahealth.com
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1374105600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1732233600000",
"number": "1376985440",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "25410 INTERSTATE 45",
"city": "SPRING",
"state": "TX",
"postal_code": "773861351",
"telephone_number": "281-367-1414",
"fax_number": "281-363-5686"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "25410 INTERSTATE 45",
"city": "SPRING",
"state": "TX",
"postal_code": "773861351",
"telephone_number": "281-367-1414",
"fax_number": "281-363-5686"
}
],
"practiceLocations": [],
"basic": {
"last_name": "EBNER",
"first_name": "KELLY",
"middle_name": "MARIE",
"name_prefix": "Mrs.",
"credential": "FNP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2013-07-18",
"last_updated": "2024-11-22",
"certification_date": "2024-11-22",
"status": "A"
},
"taxonomies": [
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "TX",
"license": "758196",
"primary": true
},
{
"code": "363L00000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner",
"state": "TX",
"license": "758196",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Spring, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 22, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.