Healthcare Provider Details

I. General information

NPI: 1154525640
Provider Name (Legal Business Name): KELLY LYNN STRATTON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2007
Last Update Date: 06/23/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 NE 10TH SUITE 4300
OKLAHOMA CITY OK
73104
US

IV. Provider business mailing address

920 STANTON L. YOUNG BLVD WP 3150
OKLAHOMA CITY OK
73104
US

V. Phone/Fax

Practice location:
  • Phone: 405-271-4088
  • Fax: 405-271-4099
Mailing address:
  • Phone: 405-271-6966
  • Fax: 405-271-3118

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number264258
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number30387
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: