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General NPI Number Information
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NPI Number | 1811985112
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Entity Type | Individual
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Provider Name | BRIAN D. KELLY D.O.
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Gender | Male
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Dates
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Enumeration Date | 10/11/2005
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Last Update Date | 11/06/2020
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Provider Practice Location Address
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Address Line | 777 AVENUE H
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City | POWELL
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State | WY
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Zip | 82435-2260
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Country | US
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Telephone | 307-754-2267
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Fax | 307-754-7217
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Provider Business Mailing Address
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Address Line | 777 AVENUE H
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City | POWELL
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State | WY
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Zip | 82435-2260
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Country | US
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Telephone | 307-754-2267
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Fax | 307-754-7217
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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 | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | OS0005851
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License Number State | FL
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