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General NPI Number Information
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NPI Number | 1740255942
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Entity Type | Individual
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Provider Name | MR. KENNETH FARREL KELLY
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Gender | Male
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Dates
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Enumeration Date | 02/21/2006
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Last Update Date | 03/19/2020
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Provider Practice Location Address
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Address Line | 2669 SCENIC DR
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City | ALAMOGORDO
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State | NM
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Zip | 88310-8700
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Country | US
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Telephone | 575-439-6100
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Fax |
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Provider Business Mailing Address
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Address Line | 2669 SCENIC DR
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City | ALAMOGORDO
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State | NM
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Zip | 88310-8700
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Country | US
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Telephone | 575-439-6100
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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 | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | MD00032760
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | MD2010-0081
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License Number State | NM
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Taxonomy #3
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | ME142464
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License Number State | FL
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Taxonomy #4
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | ME142464
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License Number State | FL
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