Kelly G Thorstad MD PA

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

L0651 Issued in TX

Legal business name

KELLY G THORSTAD MD PA

Practice address

12174 N Mo Pac Expy
Suite a
Austin, TX 78758-2910

Phone

(512) 833-7334

Fax

(512) 833-7333

NPI assigned

Apr 12, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Kelly G Thorstad, MD

Title

Physician

Phone

(512) 833-7334

Specialties & licenses 1

Addresses

Other names 1

• Lone Star Pediatrics Doing business as

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Gwen Elizabeth Collmann, RN, MSN, CPNP

  • Pediatric Nurse Practitioner
  • Austin, TX
  • NPI 1548236763
  NPD (past)
• Courtney Relyea Dudley, MD

  • Pediatrics Physician
  • Austin, TX
  • NPI 1144242173
  NPD (past)

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

{
    "created_epoch": "1176336000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1184716800000",
    "number": "1679797310",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12174 N MO PAC EXPY",
            "address_2": "SUITE A",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787582910",
            "telephone_number": "512-833-7334",
            "fax_number": "512-833-7333"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12174 N MO PAC EXPY",
            "address_2": "SUITE A",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787582910",
            "telephone_number": "512-833-7334",
            "fax_number": "512-833-7333"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KELLY G THORSTAD MD PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-12",
        "last_updated": "2007-07-18",
        "status": "A",
        "authorized_official_last_name": "THORSTAD",
        "authorized_official_first_name": "KELLY",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "512-833-7334",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": "TX",
            "license": "L0651",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lone Star Pediatrics",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Bethany Kelliher, CRNA
• Byron K. Kelln, DDS
• Elizabeth Ann Kellso
• Kelly Campbell, MD, PLLC
• Kelly G Thorstad MD PA
• Kelly M Barnhill, CN NNP
• Alice Kelly, LMFT
• Barbara M Kelly, LCSW
• Brian Kelly, LMSW, LCDC
• Caitlyn Kelly, MD

• Pediatrics Physician in Austin, TX
• Providers in Austin, TX by specialty
• Pediatrics Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 18, 2007; 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.