MEDICARE: STEPHEN POWELL KELLY M.D.

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	207W00000X	Ophthalmology Physician	E6451	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	826183444	OTHER	TX	PALMETTO GBA RR MEDICARE

Other Identifiers

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

General Provider Information

NPI Number	:	1679572515
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHEN POWELL KELLY M.D.

Provider Business Mailing Address
First Line	:	100 S PARK DR
Second Line	:
City	:	BROWNWOOD
State	:	TX
Zip	:	76801-5918
Country	:	US
Telephone Number	:	325-643-3561
Fax Number	:	325-646-0670

Provider Business Practice Location Address
First Line	:	100 S PARK DR
Second Line	:
City	:	BROWNWOOD
State	:	TX
Zip	:	76801-5918
Country	:	US
Telephone Number	:	325-643-3561
Fax Number	:	325-646-0670

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

Provider Enumeration Date	:	07/21/2005
Last Update Date	:	11/10/2009

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