Individual
RYAN JEROME KELLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1400 HIGHLAND CTR, MANKATO, MN 56001-6537
(612) 669-5506
Mailing address
6468 DEERWOOD LN, LINO LAKES, MN 55014-5428
(612) 669-5506
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
MN
Other
Enumeration date
11/21/2015
Last updated
11/21/2015
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