Provider Demographics
NPI:1699200089
Name:OXLEY, KELLYNNE
Entity Type:Individual
Prefix:MRS
First Name:KELLYNNE
Middle Name:
Last Name:OXLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 E 4TH ST
Mailing Address - Street 2:
Mailing Address - City:TIPTON
Mailing Address - State:IA
Mailing Address - Zip Code:52772-1813
Mailing Address - Country:US
Mailing Address - Phone:563-886-4155
Mailing Address - Fax:
Practice Address - Street 1:300 E 4TH ST
Practice Address - Street 2:
Practice Address - City:TIPTON
Practice Address - State:IA
Practice Address - Zip Code:52772-1813
Practice Address - Country:US
Practice Address - Phone:563-886-4155
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-24
Last Update Date:2017-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)