Provider Demographics
NPI:1235509704
Name:ALLER, KELLY (RN, MSN, FNP-C)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:ALLER
Suffix:
Gender:F
Credentials:RN, MSN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2800 TINMOUTH ST
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78748-3928
Mailing Address - Country:US
Mailing Address - Phone:610-716-9649
Mailing Address - Fax:
Practice Address - Street 1:2800 TINMOUTH ST
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78748-3928
Practice Address - Country:US
Practice Address - Phone:610-716-9649
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-28
Last Update Date:2023-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP129157363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily