Individual
EDWARD LESLIE KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1300 E CENTER ST, PROVO, UT 84606-3554
(801) 344-4400
(801) 344-4225
Mailing address
PO BOX 270, PROVO, UT 84603-0270
(801) 344-4400
(801) 344-4225
Taxonomy
Speciality
Code
Description
License number
State
2084F0202X
Forensic Psychiatry Physician
Primary
10382404-1205
UT
2084F0202X
Forensic Psychiatry Physician
26951
NE
2084F0202X
Forensic Psychiatry Physician
42929
MN
2084F0202X
Forensic Psychiatry Physician
MD00040860
WA
2084P0800X
Psychiatry Physician
26951
NE
2084P0800X
Psychiatry Physician
MD00040860
WA
2084P0804X
Child & Adolescent Psychiatry Physician
MD00040860
WA
2084P0805X
Geriatric Psychiatry Physician
MD00040860
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1013995471
—
WA
Enumeration date
01/05/2006
Last updated
03/24/2025
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