1942491139 NPI number — DR. KELLY LYNNE BIRT MD

Table of content: DR. KELLY LYNNE BIRT MD (NPI 1942491139)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942491139 NPI number — DR. KELLY LYNNE BIRT MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BIRT
Provider First Name:
KELLY
Provider Middle Name:
LYNNE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SCOTT
Provider Other First Name:
KELLY
Provider Other Middle Name:
LYNNE
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1942491139
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/24/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
448 W 19TH ST # 667
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOUSTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77008-3914
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
281-213-5218
Provider Business Mailing Address Fax Number:
281-746-9567

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
27700 NORTHWEST FWY STE 330
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CYPRESS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77433-6767
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
281-213-5218
Provider Business Practice Location Address Fax Number:
281-746-9567
Provider Enumeration Date:
08/05/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208600000X , with the licence number:  BP1-0026611 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208600000X , with the licence number: N9678 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 3870853785 . This is a "MYUTMB 3870853785" identifier . This identifiers is of the category "OTHER".