| Doctor Name: | DR. JACQUELINE KELLY |
| NPI Number: | 1699774505 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MD |
| License Number: | F6266 |
| Business Practice Address: | 300 E 8th St G-159 Austin, TX - 787013233 |
| Business Phone Number: | 5125870065 |
| Business Fax Number: | 5124697854 |
| Mailing Address: | 904 W 30th St, AUSTIN |
| State: | TX |
| Postal Code: | 787052104 |
| Phone Number: | 5125870065 |
| Fax Number: | 5124697854 |
| NPI Enumeration Date: | 07/21/2005 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | F6266 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | TX |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |