Healthcare Provider Details

I. General information

NPI: 1275584716
Provider Name (Legal Business Name): KENNETH R O'KELLEY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9430 PARKWEST BLVD SUITE 320
KNOXVILLE TN
37923
US

IV. Provider business mailing address

9430 PARKWEST BLVD SUITE
KNOXVILLE TN
37923
US

V. Phone/Fax

Practice location:
  • Phone: 865-769-4444
  • Fax: 865-769-4395
Mailing address:
  • Phone: 865-769-4444
  • Fax: 865-769-4395

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License NumberMD012163
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: