| Doctor Name: | KELLY J ELERICK |
| NPI Number: | 1003806852 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PA |
| License Number: | 915 |
| Business Practice Address: | 300 Rockefeller Dr Muskogee, OK - 744015075 |
| Business Phone Number: | 9187819466 |
| Business Fax Number: | |
| Mailing Address: | Lockbox #17, 2424 E. 21st #100 TULSA |
| State: | OK |
| Postal Code: | 741141711 |
| Phone Number: | 8663218433 |
| Fax Number: | |
| NPI Enumeration Date: | 10/24/2005 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363AM0700X |
| License Number: | 915 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OK |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Physician Assistant |
| Taxonomy Specialization: | Medical |
| Taxonomy Definition: | |