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NPI Code Detail

MEDICARE: KELLY COKER DO

MEDICARE: KELLY COKER DO
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
1207Q00000XFamily Medicine Physician01321565WI
2207Q00000XFamily Medicine Physician81246-21WI

General Provider Information

NPI Number : 1063037000
Entity Type Code : Individual
Provider Name (Legal Business Name) : KELLY COKER DO
Provider Business Mailing Address
First Line : 655 N ALVERNON WAY STE 228
Second Line :
City : TUCSON
State : AZ
Zip : 85711-1853
Country : US
Telephone Number : 520-626-7864
Fax Number :
Provider Business Practice Location Address
First Line : 655 N ALVERNON WAY STE 228
Second Line :
City : TUCSON
State : AZ
Zip : 85711-1853
Country : US
Telephone Number : 520-626-7864
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/16/2020
Last Update Date : 06/04/2025

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Directions to “ KELLY COKER DO” Practice Location

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