Shane Kelleher, PA-C

NPI #1003273939 in Fort Worth, Texas

Provider Information

NPI Number: 1003273939
Entity Type: Individual
Name: Shane Kelleher, PA-C
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Physician Assistant
Credential: PA-C
Enumeration Date: Jan 22, 2016
Last Updated: Aug 2, 2016

Practice Location

Address: 1500 COOPER ST
City: Fort Worth
State: Texas
ZIP Code: 76104-2710
Phone: (682) 885-7840

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Physician Assistant	363A00000X	Primary

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