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NPI Code Detail

MEDICARE: CAROLYN KELLY

MEDICARE: CAROLYN KELLY
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
1101YA0400XAddiction (Substance Use Disorder) Counselor437OK

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11-INDOTHER1-IND

General Provider Information

NPI Number : 1649739350
Entity Type Code : Individual
Provider Name (Legal Business Name) : CAROLYN KELLY
Provider Business Mailing Address
First Line : 3445 S SHERIDAN RD
Second Line :
City : TULSA
State : OK
Zip : 74145-1105
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3445 S SHERIDAN RD
Second Line :
City : TULSA
State : OK
Zip : 74145-1105
Country : US
Telephone Number : 918-610-3366
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/13/2019
Last Update Date : 06/11/2019

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Directions to “ CAROLYN KELLY ” Practice Location

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