Provider Demographics
NPI:1104317130
Name:MCCURLEY, KELLY A
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:A
Last Name:MCCURLEY
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 1:5350 S WESTERN AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73109-4525
Mailing Address - Country:US
Mailing Address - Phone:405-631-9991
Mailing Address - Fax:
Practice Address - Street 1:5110 W 8TH ST
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74127-7509
Practice Address - Country:US
Practice Address - Phone:918-277-3069
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-25
Last Update Date:2018-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator