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General NPI Number Information
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NPI Number | 1538418140
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Entity Type | Individual
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Provider Name | MS. BETHANY LOUISE KELLY
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Gender | Female
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Dates
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Enumeration Date | 08/29/2012
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Last Update Date | 02/14/2020
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Provider Practice Location Address
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Address Line | 6216 SOUTH LEWIS AVENUE
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City | TULSA
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State | OK
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Zip | 74136
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Country | US
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Telephone | 918-960-7852
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Fax |
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Provider Business Mailing Address
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Address Line | 11753 S 86TH EAST AVE
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City | BIXBY
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State | OK
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Zip | 74008-2101
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Country | US
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Telephone | 918-760-8129
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Fax |
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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 | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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