Provider Demographics
NPI:1447709779
Name:KELLEN, SARAH (FNP-C)
Entity type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:
Last Name:KELLEN
Suffix:
Gender:F
Credentials: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:PO BOX 92
Mailing Address - Street 2:
Mailing Address - City:WARDA
Mailing Address - State:TX
Mailing Address - Zip Code:78960-0092
Mailing Address - Country:US
Mailing Address - Phone:979-540-9857
Mailing Address - Fax:
Practice Address - Street 1:890 E TRAVIS ST
Practice Address - Street 2:
Practice Address - City:LA GRANGE
Practice Address - State:TX
Practice Address - Zip Code:78945-2364
Practice Address - Country:US
Practice Address - Phone:979-968-2000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-28
Last Update Date:2020-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP132073363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily