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Individual

MRS. KELLY LYNN DAVIS

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
18247 W RUNNING SPRINGS RD, PARK HILL, OK 74451-2017
(918) 441-6337
Mailing address
18247 W RUNNING SPRINGS RD, PARK HILL, OK 74451-2017
(918) 441-6337

Taxonomy

Speciality
Code
Description
License number
State
171W00000X
Contractor
251S00000X
Community/Behavioral Health Agency
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
200305190B
OK
Enumeration date
06/06/2012
Last updated
06/06/2012
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