MEDICARE: DR. LEE ANN KELLEY M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	25986	AZ

General Provider Information

NPI Number	:	1003868647
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LEE ANN KELLEY M.D.

Provider Business Mailing Address
First Line	:	4602 N 16TH ST STE 100
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85016-5160
Country	:	US
Telephone Number	:	602-795-1834
Fax Number	:	602-795-2608

Provider Business Practice Location Address
First Line	:	4602 N 16TH ST STE 100
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85016-5160
Country	:	US
Telephone Number	:	602-795-1834
Fax Number	:	602-795-2608

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/16/2006
Last Update Date	:	11/21/2019

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