Provider Demographics
NPI:1548545643
Name:KACZOROWSKI, KELLY A (ACNS)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:A
Last Name:KACZOROWSKI
Suffix:
Gender:F
Credentials:ACNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6400 FANNIN ST
Mailing Address - Street 2:STE 2510
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-1521
Mailing Address - Country:US
Mailing Address - Phone:713-704-6772
Mailing Address - Fax:713-704-1796
Practice Address - Street 1:929 GESSNER RD
Practice Address - Street 2:STE 2410
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77024-2515
Practice Address - Country:US
Practice Address - Phone:713-242-4410
Practice Address - Fax:713-242-4412
Is Sole Proprietor?:No
Enumeration Date:2011-10-20
Last Update Date:2011-10-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX730700364SA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health