MEDICARE: KELSEY B FERRIS

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	175T00000X	Peer Specialist

General Provider Information

NPI Number	:	1588428940
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELSEY B FERRIS

Provider Business Mailing Address
First Line	:	1107 W 1ST ST
Second Line	:
City	:	ELK CITY
State	:	OK
Zip	:	73644-4405
Country	:	US
Telephone Number	:	580-799-5642
Fax Number	:

Provider Business Practice Location Address
First Line	:	5801 BROADWAY EXT
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73118-7482
Country	:	US
Telephone Number	:	405-419-3074
Fax Number	:

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

Provider Enumeration Date	:	02/07/2024
Last Update Date	:	02/07/2024

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Directions to “ KELSEY B FERRIS ” Practice Location

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