Basic Information
| Provider Information | |||||||||
| NPI: | 1568774420 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KELLAM | ||||||||
| FirstName: | CHRISTINE | ||||||||
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| Credential: | R.N11 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5731 LAZY RIVER DR | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752412206 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2143760714 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3330 S LANCASTER RD | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752164531 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2143716639 | ||||||||
| FaxNumber: | 2143726199 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/08/2010 | ||||||||
| LastUpdateDate: | 07/08/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 517241 | TX | N | Nursing Service Providers | Registered Nurse | 163WP0809X | 517241 | TX | Y | Nursing Service Providers | Registered Nurse | Psych/Mental Health, Adult |
No ID Information.