Provider Demographics
NPI:1821017625
Name:KELLEY, NORMAN RAY (MD)
Entity Type:Individual
Prefix:DR
First Name:NORMAN
Middle Name:RAY
Last Name:KELLEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11330 Q ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68137-3679
Mailing Address - Country:US
Mailing Address - Phone:402-660-1549
Mailing Address - Fax:402-504-3496
Practice Address - Street 1:11330 Q ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68137-3679
Practice Address - Country:US
Practice Address - Phone:402-660-1549
Practice Address - Fax:402-504-3496
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE203232080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE268399OtherMR CODE
NE47073897408OtherMD#ALTID 4
NE47073897408OtherMD#ALTID 4
NEAK7274804OtherDEA NUMBER