Individual
ROGER CASEY KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1215 N BEAVER ST STE 203, FLAGSTAFF, AZ 86001-3120
(928) 773-2200
Mailing address
1200 N BEAVER ST, ATTN: PAYER CREDENTIALING, FLAGSTAFF, AZ 86001-3118
(928) 213-6235
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
OS20414
FL
207PH0002X
Hospice and Palliative Medicine (Emergency Medicine) Physician
Primary
011567
AZ
Other
Enumeration date
04/08/2021
Last updated
07/01/2025
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