Individual
MATTHEW THOMAS KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2709 NW 159TH ST, EDMOND, OK 73013-1231
(405) 696-3440
Mailing address
2709 NW 159TH ST, EDMOND, OK 73013-1231
(405) 696-3440
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
07/11/2025
Last updated
07/11/2025
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