Individual
MISS KATHLEEN ANN KELLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD, R.PH
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
RP0003513
WV
208600000X
Surgery Physician
Primary
164393-1
NY
208600000X
Surgery Physician
21979
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00010089001
SENIOR DEVICE UNIVERA
—
01
—
000527022003
BLUE CROSS BLUE SHIELD
—
05
—
01209521
—
NY
01
—
0151643931
WORKMANS COMP
—
01
—
040426000362
FEDELES CARE
—
01
—
1706438
INDEPENDENT HEALTH
—
Enumeration date
08/03/2006
Last updated
10/10/2007
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