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NPI Code Detail

MEDICARE: KELLY L. BURNETT

MEDICARE: KELLY L. BURNETT
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
1171M00000XCase Manager/Care Coordinator

General Provider Information

NPI Number : 1740383033
Entity Type Code : Individual
Provider Name (Legal Business Name) : KELLY L. BURNETT
Provider Business Mailing Address
First Line : 4436 NW 50TH ST
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73112-2212
Country : US
Telephone Number : 580-774-5631
Fax Number :
Provider Business Practice Location Address
First Line : 2250 N AIRPORT RD
Second Line :
City : WEATHERFORD
State : OK
Zip : 73096-3351
Country : US
Telephone Number : 405-424-7711
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/06/2006
Last Update Date : 07/12/2022

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