Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 174N00000X | Lactation Consultant | 11290981 | ZZ |
NPI | 1255685939 |
---|---|
Provider Name | Ms. Kristin Kelley |
First Address | Broken Arrow, OK 74014-5731 |
Second Address | Broken Arrow, OK 74014-5731 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/11/2012 |
Last Update Date | 02/11/2012 |