Healthcare Provider Details

I. General information

NPI: 1437492949
Provider Name (Legal Business Name): ANDREW LOUIS KELLY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2013
Last Update Date: 02/08/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7858 S OLYMPIA AVE
TULSA OK
74132-1857
US

IV. Provider business mailing address

6600 S YALE AVE SUITE 1400
TULSA OK
74136-3347
US

V. Phone/Fax

Practice location:
  • Phone: 918-986-9250
  • Fax: 918-986-9205
Mailing address:
  • Phone: 918-488-6001
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number30014
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: