Provider Demographics
NPI:1184679417
Name:KELLY, PATRICK F (DO)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:F
Last Name:KELLY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1650 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WOODWARD
Mailing Address - State:OK
Mailing Address - Zip Code:73801-3046
Mailing Address - Country:US
Mailing Address - Phone:580-571-8048
Mailing Address - Fax:580-571-8085
Practice Address - Street 1:1650 MAIN ST
Practice Address - Street 2:
Practice Address - City:WOODWARD
Practice Address - State:OK
Practice Address - Zip Code:73801-3046
Practice Address - Country:US
Practice Address - Phone:580-571-8048
Practice Address - Fax:580-571-8085
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2009-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK5127174400000X
OK4778207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXK5127OtherTX LICENSE NUMBER
TX171975901Medicaid
OK200248040Medicaid
TXK5127OtherTX LICENSE NUMBER
OK200248040Medicaid
OKOK403176Medicare PIN