| Organization Name: | FORT SCOTT FAMILY MEDICINE |
| NPI Number: | 1255601944 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | RICKY KELLENBERGER (PHYSICIAN) |
| Mailing Address: | 202 State St Suite A Fort Scott |
| State: | KS US |
| Postal Code: | 667012031 |
| Phone Number: | 6202233950 |
| Fax Number: | |
| NPI Enumeration Date: | 01/11/2012 |
| NPI Last Update Date: | 08/01/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 53-75555-122 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | KS |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |