Individual
KELLY HUNTLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
21132 E 640 RD, TAHLEQUAH, OK 74464-8775
(918) 456-4053
Mailing address
20150 E 630 RD, TAHLEQUAH, OK 74464-8537
(918) 456-4053
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
—
—
Other
Enumeration date
08/28/2015
Last updated
08/28/2015
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