Healthcare Provider Details

I. General information

NPI: 1518954197
Provider Name (Legal Business Name): KELLY D HALMA D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2005
Last Update Date: 10/17/2024
Certification Date: 10/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 W JEFFERSON ST
KIRKSVILLE MO
63501-1443
US

IV. Provider business mailing address

PO BOX 405827
ATLANTA GA
30384-5827
US

V. Phone/Fax

Practice location:
  • Phone: 660-626-2304
  • Fax: 660-626-2626
Mailing address:
  • Phone: 901-226-3186
  • Fax: 901-226-3160

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License Number2003004986
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2003004986
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: