Provider Demographics
NPI:1740644483
Name:KELLY, FELICITY (MSOM, L AC)
Entity type:Individual
Prefix:
First Name:FELICITY
Middle Name:
Last Name:KELLY
Suffix:
Gender:F
Credentials:MSOM, L AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2394 MEADOW DR
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:IA
Mailing Address - Zip Code:52556-8551
Mailing Address - Country:US
Mailing Address - Phone:641-781-9700
Mailing Address - Fax:
Practice Address - Street 1:206 E BURLINGTON AVE #2
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:IA
Practice Address - Zip Code:52556
Practice Address - Country:US
Practice Address - Phone:641-781-9700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-08
Last Update Date:2018-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA-86171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist