MEDICARE: KELLY RENEE HARMON 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	208000000X	Pediatrics Physician	19827	OK

General Provider Information

NPI Number	:	1780686709
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLY RENEE HARMON M.D.

Provider Business Mailing Address
First Line	:	6565 S YALE AVE
Second Line	:	SUITE 201
City	:	TULSA
State	:	OK
Zip	:	74136-8378
Country	:	US
Telephone Number	:	918-494-5170
Fax Number	:	918-494-5196

Provider Business Practice Location Address
First Line	:	6565 S YALE AVE
Second Line	:	SUITE 201
City	:	TULSA
State	:	OK
Zip	:	74136-8378
Country	:	US
Telephone Number	:	918-494-5170
Fax Number	:	918-494-5196

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

Provider Enumeration Date	:	08/10/2005
Last Update Date	:	07/08/2007

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