Provider Demographics
NPI:1154525640
Name:STRATTON, KELLY LYNN (MD)
Entity type:Individual
Prefix:DR
First Name:KELLY
Middle Name:LYNN
Last Name:STRATTON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:920 STANTON L. YOUNG BLVD
Mailing Address - Street 2:WP 3150
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73104
Mailing Address - Country:US
Mailing Address - Phone:405-271-6966
Mailing Address - Fax:405-271-3118
Practice Address - Street 1:800 NE 10TH
Practice Address - Street 2:SUITE 4300
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73104
Practice Address - Country:US
Practice Address - Phone:405-271-4088
Practice Address - Fax:405-271-4099
Is Sole Proprietor?:No
Enumeration Date:2007-06-11
Last Update Date:2017-06-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY264258208800000X
390200000X
OK30387208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200543070AMedicaid