Active NPI
Alice Bayles Kelly, DPH
- Pharmacist
- Ponca City, OK
National Provider Identifier
1922385392
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 9605
- Practice address
- 2300 N 14TH St
Ponca City, OK 74601-1729 - Phone
- (580) 767-1584
- Fax
- (580) 767-1083
- NPI assigned
- Nov 13, 2011
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 9605 | OK | Primary |
Addresses
Primary practice location
2300 N 14TH St
Ponca City, OK 74601-1729
Mailing address
2300 N 14TH St
Ponca City, OK 74601-1729
Phone (580) 767-1584
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 9605 | OK | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Walgreen Co | Past | Accepting new patients | |
| Walgreen Co | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Pharmacy
- Ponca City, OK
- NPI 1255346235
-
- Pharmacy
- Longview, TX
- NPI 1629956545
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1321142400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1321142400000",
"number": "1922385392",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2300 N 14TH ST",
"city": "PONCA CITY",
"state": "OK",
"postal_code": "746011729",
"telephone_number": "580-767-1584",
"fax_number": "580-767-1083"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2300 N 14TH ST",
"city": "PONCA CITY",
"state": "OK",
"postal_code": "746011729",
"telephone_number": "580-767-1584",
"fax_number": "580-767-1083"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KELLY",
"first_name": "ALICE",
"middle_name": "BAYLES",
"name_prefix": "Dr.",
"credential": "DPH",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2011-11-13",
"last_updated": "2011-11-13",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "OK",
"license": "9605",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Ponca City, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 13, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.