Individual
KELLYE F GREEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
111 N HUDSON ST, ALTUS, OK 73521-3811
(580) 379-4085
Mailing address
4400 N LINCOLN BLVD, OKLAHOMA CITY, OK 73105-5104
(580) 379-4085
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
—
—
Other
Enumeration date
08/13/2020
Last updated
08/13/2020
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