Individual provider · NPI-1
Ralph Kelley, DO
Family Medicine, Adult Medicine · Portageville, MO
NPI number1669589677
StatusActive
Last updated in NPPESDec 20, 2016
Details
- NPI
- 1669589677
- Entity type
- Individual (NPI-1)
- Name
- Ralph Kelley
- Credential
- DO
- Sex
- Male
- Sole proprietor
- Yes
- Enumeration date
- Aug 24, 2006
- Last updated
- Dec 20, 2016
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 207QA0505X | Family Medicine, Adult Medicine | 31361 | MO | Yes |
Practice location
314 E Main StPortageville, MO 63873-1616
Phone 573-379-3777
Mailing address
314 E Main StPortageville, MO 63873-1616
Phone 573-379-3777
Is something wrong?
This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.