Individual
MR. JONATHAN D KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA.C.
Contact information
Practice address
622 W MAPLE ST STE B, FARMINGTON, NM 87401-6589
(505) 327-4867
Mailing address
622 W MAPLE ST STE B, FARMINGTON, NM 87401-6589
(505) 327-4867
(505) 327-5355
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA054
NM
Other
Enumeration date
05/18/2007
Last updated
01/12/2023
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