| Doctor Name: | KELLY JEZAK |
| NPI Number: | 1912165044 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | 50654 |
| Business Practice Address: | 3220 Gus Thomasson Rd Ste 356 Mesquite, TX - 751504051 |
| Business Phone Number: | 9726134182 |
| Business Fax Number: | 9726861837 |
| Mailing Address: | 400 S Henderson St, FORT WORTH |
| State: | TX |
| Postal Code: | 761041017 |
| Phone Number: | 8173352583 |
| Fax Number: | 8173352597 |
| NPI Enumeration Date: | 05/27/2008 |
| NPI Last Update Date: | 05/27/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 237700000X |
| License Number: | 50654 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | TX |
| Taxonomy Type: | Speech, Language and Hearing Service Providers |
| Taxonomy Classification: | Hearing Instrument Specialist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | Individuals who test hearing for the selection, adaptation, fitting, adjusting, servicing, and sale of hearing aids. Hearing Instrument Specialist is a designation provided individuals who qualify by the National Hearing Aid Society |