Individual
KELLY P AUSTIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1903 S LIONS AVE, BROKEN ARROW, OK 74012-6932
(918) 269-5596
Mailing address
1903 S LIONS AVE, BROKEN ARROW, OK 74012-6932
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
07/15/2019
Last updated
07/15/2019
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