Provider Demographics
NPI:1073584306
Name:FLESNER, KELLY R (MD)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:R
Last Name:FLESNER
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:9228 S MINGO RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74133-5718
Mailing Address - Country:US
Mailing Address - Phone:918-592-0999
Mailing Address - Fax:918-878-2499
Practice Address - Street 1:1265 S UTICA AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74104-4243
Practice Address - Country:US
Practice Address - Phone:918-592-0999
Practice Address - Fax:918-592-1021
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2014-01-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OK23753174400000X, 207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200023810AMedicaid
OKP00251493OtherMEDICARE RAILROAD
OKP00613407OtherMEDICARE RAILROAD
OKOK700120OtherMEDICARE PTAN
OK200023810AMedicaid
OKP00251493OtherMEDICARE RAILROAD