Provider Demographics
NPI:1568780757
Name:PRATT, KELLI JO (DO)
Entity Type:Individual
Prefix:MRS
First Name:KELLI
Middle Name:JO
Last Name:PRATT
Suffix:
Gender:F
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:PO BOX 187
Mailing Address - Street 2:
Mailing Address - City:SALYERSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41465-0187
Mailing Address - Country:US
Mailing Address - Phone:606-349-5126
Mailing Address - Fax:606-349-5123
Practice Address - Street 1:835 PARKWAY DR
Practice Address - Street 2:
Practice Address - City:SALYERSVILLE
Practice Address - State:KY
Practice Address - Zip Code:41465-9250
Practice Address - Country:US
Practice Address - Phone:606-349-5126
Practice Address - Fax:606-349-5123
Is Sole Proprietor?:No
Enumeration Date:2010-05-12
Last Update Date:2013-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY03591207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine