| Doctor Name: | MIRANDA KELLY |
| NPI Number: | 1144588757 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | DNP, APRN, ACNP-BC |
| License Number: | 542153 |
| Business Practice Address: | 9250 Pinecroft Dr Shenandoah, TX - 773803218 |
| Business Phone Number: | 7138972332 |
| Business Fax Number: | |
| Mailing Address: | 1418 Castlemist Dr, SPRING |
| State: | TX |
| Postal Code: | 773862262 |
| Phone Number: | 2817037976 |
| Fax Number: | |
| NPI Enumeration Date: | 05/02/2012 |
| NPI Last Update Date: | 09/09/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LA2100X |
| License Number: | 542153 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | TX |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Acute Care |
| Taxonomy Definition: | |