Denise Kellum, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA05852 Issued in TX

Practice address

7323 Marbach Rd Ste 104
San Antonio, TX 78227-1905

Phone

(210) 231-2586

Fax

(210) 231-2583

NPI assigned

Jul 3, 2008

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 4

Other names 1

• Denise Kellum Former name

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

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

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

{
    "created_epoch": "1215043200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1765324800000",
    "number": "1396908950",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7323 MARBACH RD STE 104",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782271905",
            "telephone_number": "210-674-0257",
            "fax_number": "210-369-9064"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7323 MARBACH RD STE 104",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782271905",
            "telephone_number": "210-231-2586",
            "fax_number": "210-231-2583"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLUM",
        "first_name": "DENISE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-07-03",
        "last_updated": "2025-12-10",
        "certification_date": "2025-12-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TX",
            "license": "PA05852",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP/BILLING NPI#",
            "identifier": "1508813494",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHYSICIAN ASSISTANT LICENSE#",
            "identifier": "PA05852",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1396908950",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INDIVIDUAL TAXONOMY",
            "identifier": "363A00000X",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "DENISE",
            "last_name": "KELLUM",
            "credential": "SOLIS",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Kellum Physician Partners, PA
• Kellum Physician Partners, PA
• Alexandra Cortez Kellum, DO
• Ashley Renee Kellum, RBT
• Daniel H Kellum Sr., DO
• John Hansford Kellum, M.D.
• Dalisa Kelly Bacon
• Carol Ann Kelly Dilworth, L.B.S.W
• Kelly J Smith MD PA
• Kelly J Smith MD PA

• Physician Assistant in San Antonio, TX
• Providers in San Antonio, TX by specialty
• Physician Assistant in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 10, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.