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General NPI Number Information
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NPI Number | 1689768285
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Entity Type | Organization
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Legal Business Name | GREGORY P. KELLEY D.O. INC.
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Dates
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Enumeration Date | 10/03/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 13190 NE 23RD STREET
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City | CHOCTAW
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State | OK
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Zip | 73020
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Country | US
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Telephone | 405-769-7201
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Fax | 405-769-4034
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Provider Business Mailing Address
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Address Line | 13190 NE 23RD STREET
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City | CHOCTAW
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State | OK
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Zip | 73020
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Country | US
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Telephone | 405-769-7201
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Fax | 405-769-4034
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. NAN KELLEY
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Credential |
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Telephone | 405-769-7201
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 2127
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License Number State | OK
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