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General NPI Number Information
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NPI Number | 1184679417
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Entity Type | Individual
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Provider Name | PATRICK F KELLY D.O.
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Gender | Male
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Dates
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Enumeration Date | 05/24/2006
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Last Update Date | 08/14/2009
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Provider Practice Location Address
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Address Line | 1650 MAIN ST
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City | WOODWARD
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State | OK
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Zip | 73801-3046
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Country | US
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Telephone | 580-571-8048
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Fax | 580-571-8085
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Provider Business Mailing Address
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Address Line | 1650 MAIN ST
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City | WOODWARD
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State | OK
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Zip | 73801-3046
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Country | US
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Telephone | 580-571-8048
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Fax | 580-571-8085
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | K5127
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 4778
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License Number State | OK
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