Organization
STEPHEN P. KELLY, M.D., P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DIANE NEWTON (MEDICAL SECRETARY)
(325) 643-3561
Entity
Organization
Contact information
Practice address
100 S PARK DR, BROWNWOOD, TX 76801-5918
(325) 643-3561
(325) 646-0670
Mailing address
100 S PARK DR, BROWNWOOD, TX 76801-5918
(325) 643-3561
(325) 646-0670
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
E6451
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
089916302
—
TX
01
—
826183444
PALMETTO GBA RR MEDICARE
TX
Enumeration date
11/12/2009
Last updated
07/21/2010
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