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Individual

KELLY G WEST

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PAC

Contact information

Practice address
6161 S YALE AVE, TULSA, OK 74136-1902
(918) 494-1805
(918) 494-4573
Mailing address
6600 S YALE AVE STE 1200, TULSA, OK 74136-3361
(918) 488-6687
(918) 488-6098

Taxonomy

Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA1716
OK

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
PENDING
RAILROAD MEDICARE
OK
05
PENDING
OK
Enumeration date
02/06/2008
Last updated
03/05/2018
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