| C Kelly Family Clinic, Pa | |
|
794 Generations Dr., Ste. 100 New Braunfels TX 78130-2460 | |
| (830) 214-6411 | |
| (830) 626-8800 |
| Full Name | C Kelly Family Clinic, Pa |
|---|---|
| Speciality | Family Medicine |
| Location | 794 Generations Dr., Ste. 100, New Braunfels, Texas |
| Authorized Official Name and Position | Austin Kelly (SECRETARY) |
| Authorized Official Contact | 8302146411 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| C Kelly Family Clinic, Pa 794 Generations Dr., Ste. 100 New Braunfels TX 78130 Ph: (830) 214-6411 | C Kelly Family Clinic, Pa 794 Generations Dr., Ste. 100 New Braunfels TX 78130-2460 Ph: (830) 214-6411 |
| NPI Number | 1093033573 |
|---|---|
| Provider Enumeration Date | 05/09/2010 |
| Last Update Date | 11/19/2018 |
| Medicare PECOS PAC ID | 4688798887 |
|---|---|
| Medicare Enrollment ID | O20100825000075 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1093033573 | NPI | - | NPPES |
| 2151524-01 | Medicaid | TX | |
| 215152402 | Medicaid | TX |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | N5766 (Texas) | Primary |
| Provider Name | Cecily H Kelly |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1881887545 PECOS PAC ID: 6305960501 Enrollment ID: I20100825000088 |
| Provider Name | Jennifer A Ayars |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1912345752 PECOS PAC ID: 3072884006 Enrollment ID: I20170809000737 |
| Provider Name | Jessica Isoke Edwards |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1265848121 PECOS PAC ID: 3971874827 Enrollment ID: I20180314001010 |
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