Provider Demographics
NPI:1821791179
Name:KOKOPELLI CLINIC OF MCCAMEY
Entity Type:Organization
Organization Name:KOKOPELLI CLINIC OF MCCAMEY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHELLY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:ADAMS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:806-316-7173
Mailing Address - Street 1:PO BOX 1889
Mailing Address - Street 2:
Mailing Address - City:MC CAMEY
Mailing Address - State:TX
Mailing Address - Zip Code:79752-1889
Mailing Address - Country:US
Mailing Address - Phone:806-316-7173
Mailing Address - Fax:
Practice Address - Street 1:510 W 11TH ST
Practice Address - Street 2:
Practice Address - City:MC CAMEY
Practice Address - State:TX
Practice Address - Zip Code:79752-1821
Practice Address - Country:US
Practice Address - Phone:806-316-7173
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-24
Last Update Date:2023-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty