Provider Demographics
NPI:1427615418
Name:KELLY, ALESSANDRA MORGAN
Entity type:Individual
Prefix:
First Name:ALESSANDRA
Middle Name:MORGAN
Last Name:KELLY
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 1:7501 MEADOW LAKE DR
Mailing Address - Street 2:
Mailing Address - City:YUKON
Mailing Address - State:OK
Mailing Address - Zip Code:73099-9796
Mailing Address - Country:US
Mailing Address - Phone:405-549-8749
Mailing Address - Fax:
Practice Address - Street 1:7501 MEADOW LAKE DR
Practice Address - Street 2:
Practice Address - City:YUKON
Practice Address - State:OK
Practice Address - Zip Code:73099-9796
Practice Address - Country:US
Practice Address - Phone:405-549-8749
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-24
Last Update Date:2019-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist