Individual
KELLI M WARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
2090 SMOKETREE AVE N, LAKE HAVASU CITY, AZ 86403-5806
(928) 854-1800
(928) 854-1847
Mailing address
PO BOX 3630, FLAGSTAFF, AZ 86003-3630
(928) 213-6100
(928) 774-6687
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
3425
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
470724
—
AZ
Enumeration date
06/09/2006
Last updated
05/18/2010
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