KELLY BORA (NPI# 1639513971) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1639513971 |
| Entity Type | Individual |
| Full Name | KELLY BORA |
| Practice Address |
12221 N Mopac Expy Austin TX 78758 |
| Mailing Address |
12221 N Mopac Expy Austin TX 78758-2401 |
| Practice Telephone | 5129011000 |
| Enumeration Date | 2013-04-17 |
| Last Update Date | 2019-07-19 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2080P0203X |
Pediatrics Specialization: Pediatric Critical Care Medicine |
S2242 | TX | Allopathic & Osteopathic Physicians |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 4301 W Markham St, Little Rock, AR 722057101 | 5016867000 |
| Street Address |
12221 N MOPAC EXPY |
| City | AUSTIN |
| State | TX |
| Zip Code | 78758 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1245238534 | Malik M Merchant | Internal Medicine | 12221 N Mopac Expy, Austin, TX 78758-2401 | 2005-07-11 |
| 1477151413 | Jessica C. Heim | Registered Nurse | 12221 N Mopac Expy, Austin, TX 78758-2401 | 2020-10-13 |
| 1639786387 | Renee Yvonne Vilaire | Registered Nurse | 12221 N Mopac Expy, Austin, TX 78758-2401 | 2020-09-28 |
| 1376150052 | Kimberly Marie Labinsky | Registered Nurse | 12221 N Mopac Expy, Austin, TX 78758-2401 | 2020-09-28 |
| 1912515123 | Renee Hyder | Nurse Practitioner | 12221 N Mopac Expy, Austin, TX 78758-2401 | 2020-07-14 |
| 1255963468 | Melanie Marie Vague | Registered Nurse | 12221 N Mopac Expy, Austin, TX 78758-2401 | 2020-02-05 |
| 1730728684 | Sally Anne Jung | Registered Nurse | 12221 N Mopac Expy, Austin, TX 78758-2401 | 2019-12-24 |
| 1831735505 | Sadie Christine Laddusaw | Anesthesiologist Assistant | 12221 N Mopac Expy, Austin, TX 78758-2401 | 2019-11-18 |
| 1003386285 | Lauren Van Orden | Speech-Language Pathologist | 12221 N Mopac Expy, Austin, TX 78758-2401 | 2018-11-29 |
| 1114406246 | Sarah Mcbride | Clinical Nurse Specialist | 12221 N Mopac Expy, Austin, TX 78758 | 2018-08-09 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1225644065 | Seton Family of Doctors | Internal Medicine | 3001 Palm Way, D1 : 134-138, Austin, TX 78758 | 2020-09-17 |
| 1083243661 | Donna Bella Laurel Portillo | Pharmacist | 12221 N Mopac Expwy, Austin, TX 78758 | 2020-04-05 |
| 1881249092 | Elizabeth Logan Anderson | Behavioral Analyst | 2100 Kramer Ln., Suite 150, Austin, TX 78758 | 2019-08-05 |
| 1295388502 | Bridget Sue Morgan | Behavioral Analyst | 2100 Kramer Ln #150, Austin, TX 78758 | 2019-07-17 |
| 1508326885 | Jonathan James Runnels | Anesthesiologist Assistant | 12221n Mopac, Austin, TX 78758 | 2019-03-22 |
| 1427527324 | Nayely Gutierrez | Dietitian, Registered | 8606 Delaware Ct, Austin, TX 78758 | 2018-11-20 |
| 1720569635 | Shari Wright | Licensed Vocational Nurse | 12349 Metric Blvs # 425, Austin, TX 78758 | 2018-08-28 |
| 1528545456 | Alexis N Bongiorno | Registered Nurse | 11901 Hobby Horse Court, 1516, Austin, TX 78758 | 2018-07-24 |
| 1679072573 | Lori Scott | Counselor | 1600 Payton Gin Road, Austin, TX 78758 | 2018-02-06 |
| 1003322488 | Lisa Robyn Lee | Behavior Technician | 2018 W Rundberg Ln, #13d, Austin, TX 78758 | 2017-12-20 |
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| Taxonomy Code | 2080P0203X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pediatrics |
| Specialization | Pediatric Critical Care Medicine |
| A pediatrician expert in advanced life support for children from the term or near-term neonate to the adolescent. This competence extends to the critical care management of life-threatening organ system failure from any cause in both medical and surgical patients and to the support of vital physiological functions. This specialist may have administrative responsibilities for intensive care units and also facilitates patient care among other specialists. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition changed, source added] Additional Resources: American Board of Pediatrics, 2007. http://www.abp.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Pediatrics. ACGME Accredited Residency Program Requirements: 2 years of training with 3 years Pediatrics plus 1 year Pediatric Critical Care for certification for a total of 6 years. ABMS Approved Subspecialty Certificate (Pediatrics) |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497222400 | Justin K Sandefur | Pediatrics | 4900 Mueller Blvd, Austin, TX 78723-3079 | 2018-10-28 |
| 1710366893 | Sai Krishna Surapa Raju | Pediatrics | 4900 Mueller Blvd, Austin, TX 78723-3079 | 2015-05-22 |
| 1154603512 | Kyle Scott Miller | Pediatrics | 4900 Mueller Blvd, Austin, TX 78723-3079 | 2011-09-12 |
| 1477849313 | Milton Meadows | Pediatrics | 4900 Mueller Blvd, Austin, TX 78723-3079 | 2011-06-20 |
| 1295038479 | Meghan Lane | Pediatrics | 4900 Mueller Blvd, Austin, TX 78723-3079 | 2010-12-10 |
| 1518019520 | Taj M Khan | Pediatrics | 12221 N Mopac Expy, Austin, TX 78758-2401 | 2007-01-18 |
| 1427138833 | Tandy Alice Mellard | Pediatrics | 4900 Mueller Blvd, Austin, TX 78723-3079 | 2006-10-17 |
| 1073615977 | Kyle Lieppman | Pediatrics | 4900 Mueller Blvd, Austin, TX 78723-3079 | 2006-09-01 |
| 1184731788 | Alexandra Wilson | Pediatrics | 4900 Mueller Blvd, C/o Dell Children's Medical Center, Austin, TX 78723-3079 | 2006-08-23 |
| 1548373079 | Michael Auth | Pediatrics | 4900 Mueller Blvd, C/o Dell Children's Medical Center, Austin, TX 78723-3079 | 2006-08-17 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.