Individual
KIMBERLY D KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW, DSW
Contact information
Practice address
407 W SOUTH AVE, PONCA CITY, OK 74601-6133
(580) 749-5056
Mailing address
407 W SOUTH AVE, PONCA CITY, OK 74601-6133
(580) 749-5056
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
8566
OK
Other
Enumeration date
11/10/2022
Last updated
11/10/2022
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