Individual
DR. KEVIN EDWARD KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
651 COLLIERS WAY STE 307, WEIRTON, WV 26062-5055
(304) 797-6197
Mailing address
651 COLLIERS WAY STE 300, WEIRTON, WV 26062-5058
(304) 797-6404
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
24684
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
364935
—
AZ
01
—
AZ0834560
BLUE CROSS BLUE SHIELD
—
Enumeration date
03/07/2007
Last updated
10/25/2022
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