MEDICARE: STEPHANIE ELAINE KELLY D.O.

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
1	2085R0202X	Diagnostic Radiology Physician	3749	OK
2	2085R0202X	Diagnostic Radiology Physician	A-2464-21	NM

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1598721755
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE ELAINE KELLY D.O.

Provider Business Mailing Address
First Line	:	DEPARTMENT 960591
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73196-0591
Country	:	US
Telephone Number	:	800-637-8884
Fax Number	:	484-224-2926

Provider Business Practice Location Address
First Line	:	3300 NW EXPRESSWAY
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73112-4418
Country	:	US
Telephone Number	:	405-949-3011
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/25/2006
Last Update Date	:	04/09/2026

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