Individual
LOUISSA DAWN KELLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
118 W KEETOOWAH ST, TAHLEQUAH, OK 74464-3820
(918) 457-7793
Mailing address
118 W KEETOOWAH ST, TAHLEQUAH, OK 74464-3820
(918) 457-7793
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
—
—
Other
Enumeration date
09/06/2023
Last updated
09/06/2023
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