Individual
KEVIN J KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
4049 S CAMPBELL AVE, SPRINGFIELD, MO 65807-5303
(417) 890-5550
(417) 889-6898
Mailing address
1643 MEADOW VIEW RD, OZARK, MO 65721-7913
(417) 725-2135
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
2007009235
MO
Other
Enumeration date
05/24/2007
Last updated
07/08/2007
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