Provider Demographics
NPI:1619591963
Name:KELLY, SAMANTHA PATEL (MD)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:PATEL
Last Name:KELLY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 STONE CREEK BLVD
Mailing Address - Street 2:
Mailing Address - City:YUKON
Mailing Address - State:OK
Mailing Address - Zip Code:73099-4432
Mailing Address - Country:US
Mailing Address - Phone:405-740-6983
Mailing Address - Fax:
Practice Address - Street 1:800 STONE CREEK BLVD
Practice Address - Street 2:
Practice Address - City:YUKON
Practice Address - State:OK
Practice Address - Zip Code:73099-4432
Practice Address - Country:US
Practice Address - Phone:405-740-6983
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-02
Last Update Date:2020-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program