Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VX0000X | Obstetrician | MD012163 | TN |
NPI | 1275584716 |
---|---|
Provider Name | Kenneth R O'kelley |
First Address | Knoxville, TN 37923 |
Second Address | Knoxville, TN 37923 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/05/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3034509 | (05) | TN |
A99801 | (02) | TN |