Individual
GREGORY THOMAS KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
200 HAWKINS DR, IOWA CITY, IA 52242-1009
(319) 356-2920
(319) 384-6389
Mailing address
200 HAWKINS DR, IOWA CITY, IA 52242-1009
(319) 356-2920
(319) 384-6389
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
000645
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
46091
WELLMARK BCBS
IA
Enumeration date
10/13/2005
Last updated
12/11/2007
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