Organization
FORT SCOTT FAMILY MEDICINE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RICKY KELLENBERGER D.O (PHYSICIAN)
(620) 224-3511
Entity
Organization
Contact information
Practice address
202 STATE ST, SUITE A, FORT SCOTT, KS 66701-2031
(620) 223-3950
Mailing address
202 STATE ST, SUITE A, FORT SCOTT, KS 66701-2031
(620) 223-3950
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
53-75555-122
KS
Other
Enumeration date
01/11/2012
Last updated
08/01/2012
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