Kelly R. Kunkel, M.D., P.a.

Primary specialty

SpecialistTaxonomy code 174400000X

License

208650122X Issued in TX

Legal business name

KELLY R. KUNKEL, M.D., P.A.

Practice address

1830 8TH Ave
Fort Worth, TX 76110-1391

Phone

(817) 335-5200

Fax

(817) 923-0780

NPI assigned

Dec 31, 2013

Organization subpart

No

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

Authorized official

Name

Dr. Kelly Raymond Kunkel, M.D.

Title

President

Phone

(817) 335-5200

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1388448000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1388448000000",
    "number": "1902227424",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1830 8TH AVE",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761101391",
            "telephone_number": "817-335-5200",
            "fax_number": "817-923-0780"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1830 8TH AVE",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761101391",
            "telephone_number": "817-335-5200",
            "fax_number": "817-923-0780"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KELLY R. KUNKEL, M.D., P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-12-31",
        "last_updated": "2013-12-31",
        "status": "A",
        "authorized_official_last_name": "KUNKEL",
        "authorized_official_first_name": "KELLY",
        "authorized_official_middle_name": "RAYMOND",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "817-335-5200",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Specialist",
            "state": "TX",
            "license": "208650122X",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE IDENTIFICATION NUMBER",
            "identifier": "0025AA",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Suzanne B Kelley, MD
• Trent Kelley
• Kellie McLarty LPC
• Kelley G Kellogg, DO
• Kelly Blair D.D.S., PLLC
• Allan Rowan Kelly, M.D.
• Chandler T Kelly, OTR, OTD
• David C Kelly, PA
• Derek Keith Kelly, MD
• Lauren Kelly

• Specialist in Fort Worth, TX
• Providers in Fort Worth, TX by specialty
• Specialist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 31, 2013; 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.