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NPI Code Detail

MEDICARE: KELLY PLUNKETT

MEDICARE: KELLY PLUNKETT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1171M00000XCase Manager/Care Coordinator

General Provider Information

NPI Number : 1396110532
Entity Type Code : Individual
Provider Name (Legal Business Name) : KELLY PLUNKETT
Provider Business Mailing Address
First Line : 1616 N GILCREASE MUSEUM RD
Second Line :
City : TULSA
State : OK
Zip : 74127-2101
Country : US
Telephone Number : 918-804-8987
Fax Number :
Provider Business Practice Location Address
First Line : 1616 N GILCREASE MUSEUM RD
Second Line :
City : TULSA
State : OK
Zip : 74127-2101
Country : US
Telephone Number : 918-804-8987
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/12/2015
Last Update Date : 12/12/2015

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Directions to “ KELLY PLUNKETT ” Practice Location

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