Individual
KAELLA R KELLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2225 N UNION ST., PONCA CITY, OK 74601-1536
(580) 308-5515
Mailing address
2225 N UNION ST., PONCA CITY, OK 74601-1536
(580) 308-5515
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
N084074652
OK
Other
Enumeration date
11/16/2020
Last updated
01/22/2021
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