Individual
AMMIE WALL KELLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
8921 S MINGO RD, TULSA, OK 74133-5841
(918) 252-8890
Mailing address
405 W KEYWEST ST, BROKEN ARROW, OK 74011
(918) 527-1401
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
102373
OK
363LF0000X
Family Nurse Practitioner
Primary
R0102373
OK
Other
Enumeration date
04/22/2019
Last updated
03/19/2026
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