Active NPI
Patty Mathis Kelley, BSN RN
- Registered Nurse
- Tyler, TX
National Provider Identifier
1477028876
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Nurse
- License
- 753299
- Practice address
- 100 E Ferguson St
Tyler, TX 75702-5759 - Phone
- (903) 705-0070
- NPI assigned
- Oct 11, 2018
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | 753299 | TX | Primary |
Addresses
Primary practice location
100 E Ferguson St
Tyler, TX 75702-5759
Mailing address
545 Prairie Dell St
Lewisville, TX 75067-3603
Phone (806) 339-1420
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)
- Not enrolled
- Credentials
- Bachelor on Science - Nursing, Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 753299 | TX | MD | Registered Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1539216000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1604448000000",
"number": "1477028876",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "545 PRAIRIE DELL ST",
"city": "LEWISVILLE",
"state": "TX",
"postal_code": "750673603",
"telephone_number": "806-339-1420"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "100 E FERGUSON ST",
"city": "TYLER",
"state": "TX",
"postal_code": "757025759",
"telephone_number": "903-705-0070"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KELLEY",
"first_name": "PATTY",
"middle_name": "MATHIS",
"credential": "BSN RN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-10-11",
"last_updated": "2020-11-04",
"certification_date": "2020-11-04",
"status": "A"
},
"taxonomies": [
{
"code": "163W00000X",
"taxonomy_group": "",
"desc": "Registered Nurse",
"state": "TX",
"license": "753299",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Tyler, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 4, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.