Kelley Eileen Brister, PTA

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

2016465 Issued in TX

Practice address

351 Bosque Bend LN
China Spring, TX 76633-2753

Phone

(254) 749-1398

NPI assigned

Aug 29, 2018

Last updated

Aug 29, 2018By the provider in NPPES

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1535500800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1535500800000",
    "number": "1518449347",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "351 BOSQUE BEND LN",
            "city": "CHINA SPRING",
            "state": "TX",
            "postal_code": "766332753"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "351 BOSQUE BEND LN",
            "city": "CHINA SPRING",
            "state": "TX",
            "postal_code": "766332753",
            "telephone_number": "254-749-1398"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "300 TX 36",
            "address_purpose": "LOCATION",
            "city": "Gatesville",
            "state": "TX",
            "postal_code": "76633",
            "country_code": "US",
            "telephone_number": "254-865-7575",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BRISTER",
        "first_name": "KELLEY",
        "middle_name": "EILEEN",
        "name_prefix": "Ms.",
        "credential": "PTA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-08-29",
        "last_updated": "2018-08-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "TX",
            "license": "2016465",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Physical Therapy Assistant in China Spring, TX
• Providers in China Spring, TX by specialty
• Physical Therapy Assistant in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 29, 2018; 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.