Provider Demographics
NPI:1770720005
Name:KELLY, PAIGE A (ARNP)
Entity type:Individual
Prefix:MS
First Name:PAIGE
Middle Name:A
Last Name:KELLY
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:3366 NW EXPRESSWAY
Mailing Address - Street 2:SUITE 550
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-4489
Mailing Address - Country:US
Mailing Address - Phone:405-942-5442
Mailing Address - Fax:405-942-6448
Practice Address - Street 1:3366 NW EXPRESSWAY
Practice Address - Street 2:SUITE 550
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-4489
Practice Address - Country:US
Practice Address - Phone:405-942-5442
Practice Address - Fax:405-942-6448
Is Sole Proprietor?:No
Enumeration Date:2009-01-08
Last Update Date:2010-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0081209363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner