Individual
MRS. KELLY DAWN MOAK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
14321 NE 23RD ST, CHOCTAW, OK 73020-8624
(405) 342-0255
(405) 610-6960
Mailing address
2100 W IOWA AVE, CHICKASHA, OK 73018-2736
(405) 224-2100
(405) 779-2244
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
2482
OK
Other
Enumeration date
09/14/2006
Last updated
03/17/2018
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