Provider Demographics
NPI:1639069156
Name:KELLEY-MOTA, MYRA EUGENIA (LVN)
Entity type:Individual
Prefix:
First Name:MYRA
Middle Name:EUGENIA
Last Name:KELLEY-MOTA
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7236 ROYAL ARMS DR APT A
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912-1537
Mailing Address - Country:US
Mailing Address - Phone:915-471-9201
Mailing Address - Fax:
Practice Address - Street 1:7236 ROYAL ARMS DR APT A
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79912-1537
Practice Address - Country:US
Practice Address - Phone:915-471-9201
Practice Address - Fax:915-471-9201
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-07
Last Update Date:2025-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX329342164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse