Gregory P. Kelley D.O. Inc.
Organization Active NPI Family Medicine Physician · Choctaw, OK
NPI 1689768285 · NPPES record last updated Aug 22, 2020
Key facts
- NPI
- 1689768285
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 2127 (OK)
- Legal business name
- GREGORY P. KELLEY D.O. INC.
- Practice address
- 13190 NE 23Rd Street
Choctaw, OK 73020 - Phone
- (405) 769-7201
- Fax
- (405) 769-4034
- NPI assigned
- Oct 3, 2006
- Organization subpart
- No
Authorized official
- Name
- Mrs. Nan Kelley
- Title
- Office Manager
- Phone
- (405) 769-7201
Practitioners 1
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 37D0469542 | Kelley Family Clinic | Certificate of waiver | Jun 5, 2027 |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | 2127 | OK | Yes |
Addresses
Primary practice location
13190 NE 23Rd Street
Choctaw, OK 73020
Mailing address
13190 NE 23Rd Street
Choctaw, OK 73020
Phone (405) 769-7201
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 452023528002 | Other | OK | BC/BS FEDERAL |
| C2138 | Other | OK | BLUELINCS HMO |
| 452023528002 | Other | OK | CGS CLAIMS |
| 4335747 | Other | OK | AETNA HEALTHCARE |
| 452023528002 | Other | OK | BLUE CROSS BLUE SHIELD |
| 73020A002 | Other | OK | TRICARE SOUTH /LIFE |
Other names
- kelley family clinic
Other providers in Choctaw, OK
- Allie Good
- Casey Goodall
- Leslie Floyd Goodman
- Tara Goodson
- Kelly Rae Goodwin
- Tenisha Celess Guevara
- Jessica H Guthrie
- Shelley Dawn Hall
- Cara Michelle Hammon
- Anna M Hatchell
All providers in Choctaw, OK · Family Medicine Physician in Oklahoma
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 22, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.