Individual
LISA EMILY KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
10257 N BRIDGEWATER CIR, OWASSO, OK 74055-7734
(254) 368-7638
Mailing address
10257 N BRIDGEWATER CIR, OWASSO, OK 74055-7734
(254) 368-7638
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
R0097954
OK
Other
Enumeration date
10/17/2024
Last updated
10/17/2024
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