Provider Demographics
NPI:1538802590
Name:KELLY, MELISSA ANN (RN, CST, BSN)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:ANN
Last Name:KELLY
Suffix:
Gender:F
Credentials:RN, CST, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1421 CLOUD RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912-7700
Mailing Address - Country:US
Mailing Address - Phone:915-710-6833
Mailing Address - Fax:
Practice Address - Street 1:DR. HITZELBERGER STRASSE
Practice Address - Street 2:
Practice Address - City:LANDSTUHL
Practice Address - State:NY
Practice Address - Zip Code:09180
Practice Address - Country:US
Practice Address - Phone:314-590-7258
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-18
Last Update Date:2023-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX802935163W00000X, 2086S0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
Yes163W00000XNursing Service ProvidersRegistered Nurse