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General NPI Number Information
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NPI Number | 1437202819
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Entity Type | Organization
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Legal Business Name | TERRI KELLEY
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Dates
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Enumeration Date | 01/19/2007
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Last Update Date | 01/12/2009
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Provider Practice Location Address
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Address Line | 1801 KATHERINE AVE
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City | JOPLIN
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State | MO
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Zip | 64801-5888
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Country | US
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Telephone | 417-626-9729
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Fax | 471-206-4113
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Provider Business Mailing Address
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Address Line | PO BOX 2966 1801 KATHERINE ST
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City | JOPLIN
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State | MO
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Zip | 64803-2966
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Country | US
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Telephone | 417-626-9729
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Fax | 471-206-4113
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Authorized Official
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Title or Position | PRESIDENT
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Name | MICHAEL KELLEY
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Credential |
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Telephone | 417-626-9729
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 335V00000X
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Taxonomy Name | Portable X-ray and/or Other Portable Diagnostic Imaging Supplier
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License Number | 309
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License Number State | MO
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