Individual
KELLI RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2238 W KINGSLEY ST, SPRINGFIELD, MO 65807-5456
(417) 831-0150
Mailing address
440 E TAMPA ST, SPRINGFIELD, MO 65806-1131
(417) 831-0150
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
2002011659
MO
Other
Enumeration date
04/21/2026
Last updated
04/21/2026
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