Provider Demographics
NPI:1861068769
Name:KELLY, DANIELLE ANALISA
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:ANALISA
Last Name:KELLY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DANIELLE
Other - Middle Name:ANALISA
Other - Last Name:FIEGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4103 JOSH DR
Mailing Address - Street 2:
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76542-7845
Mailing Address - Country:US
Mailing Address - Phone:702-822-0118
Mailing Address - Fax:
Practice Address - Street 1:1200 E STAN SCHLUETER LOOP STE 108
Practice Address - Street 2:
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76542-5482
Practice Address - Country:US
Practice Address - Phone:727-278-2479
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-01
Last Update Date:2021-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician