Individual
PROF. CARLISSIA KELLEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
421 W SOUTH AVE, VINITA, OK 74301-4143
(918) 256-3131
(918) 256-8507
Mailing address
421 W SOUTH AVE, VINITA, OK 74301-4143
(918) 256-3131
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
OK
Other
Enumeration date
07/23/2024
Last updated
07/23/2024
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