Individual
KELLEY JEAN JOY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
109 N FAIRLAND ST, STE 105, PRYOR, OK 74361-4203
(918) 825-9900
(918) 825-4341
Mailing address
110 HILLVIEW DR, JOPLIN, MO 64804-5229
(918) 825-9900
(918) 825-4341
Taxonomy
Speciality
Code
Description
License number
State
204D00000X
Neuromusculoskeletal Medicine & OMM Physician
115577
MO
204D00000X
Neuromusculoskeletal Medicine & OMM Physician
Primary
3926
OK
207Q00000X
Family Medicine Physician
115577
MO
207Q00000X
Family Medicine Physician
3926
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
030474832
TAX ID #
OK
05
—
100195450B
—
OK
Enumeration date
07/18/2006
Last updated
10/30/2019
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