=====================================================
General NPI Number Information
=====================================================
NPI Number | 1518954197
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KELLY D HALMA D.O.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/29/2005
-----------------------------------------------------
Last Update Date | 10/17/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 800 W JEFFERSON ST
-----------------------------------------------------
City | KIRKSVILLE
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63501-1443
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 660-626-2304
-----------------------------------------------------
Fax | 660-626-2626
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 405827
-----------------------------------------------------
City | ATLANTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30384-5827
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 901-226-3186
-----------------------------------------------------
Fax | 901-226-3160
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 204D00000X
-----------------------------------------------------
Taxonomy Name | Neuromusculoskeletal Medicine & OMM Physician
-----------------------------------------------------
License Number | 2003004986
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 2003004986
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------