Organization
OWEN L KELLY MD PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. OWEN L KELLY (MD)
(479) 890-5355
Entity
Organization
Contact information
Practice address
401 N PHOENIX AVE, RUSSELLVILLE, AR 72801-2844
(479) 890-5355
(479) 890-5366
Mailing address
401 NORTH PHOENIX AVE, RUSSELLVILLE, AR 72801-1146
(479) 890-5355
(479) 890-5366
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
E3477
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
182582002
—
AR
Enumeration date
06/10/2010
Last updated
12/23/2011
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