Active NPI
Ryan Kelley
- Surgical Technologist
- Fort Worth, TX
National Provider Identifier
1720010663
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgical Technologist
- License
- 86186
- Practice address
- 3863 SW Loop 820
Fort Worth, TX 76133-2064 - Phone
- (817) 294-7444
- NPI assigned
- Jul 7, 2006
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Surgical Technologist | 246ZS0410X | 86186 | TX | Primary |
Addresses
Primary practice location
3863 SW Loop 820
Fort Worth, TX 76133-2064
Mailing address
3863 SW Loop 820
Fort Worth, TX 76133-2064
Phone (817) 294-7444
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 86186 | TX | MD | Surgical Technologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1152230400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1720010663",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3863 SW LOOP 820",
"city": "FORT WORTH",
"state": "TX",
"postal_code": "761332064",
"telephone_number": "817-294-7444"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3863 SW LOOP 820",
"city": "FORT WORTH",
"state": "TX",
"postal_code": "761332064",
"telephone_number": "817-294-7444"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KELLEY",
"first_name": "RYAN",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-07-07",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "246ZS0410X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Other, Surgical Technologist",
"state": "TX",
"license": "86186",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fort Worth, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 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.