Provider Demographics
NPI:1861098535
Name:MARSH, KILEY (APRN, PNP-PC)
Entity type:Individual
Prefix:
First Name:KILEY
Middle Name:
Last Name:MARSH
Suffix:
Gender:F
Credentials:APRN, PNP-PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 TRAILHOUSE LN APT 1113
Mailing Address - Street 2:
Mailing Address - City:FORNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75126-3158
Mailing Address - Country:US
Mailing Address - Phone:903-603-6031
Mailing Address - Fax:
Practice Address - Street 1:2715 OSLER DR
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75051-1051
Practice Address - Country:US
Practice Address - Phone:972-206-2940
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-08
Last Update Date:2020-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1004526363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics