| Doctor Name: | KELLY M DENNIS |
| NPI Number: | 1386770246 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PA-C |
| License Number: | 1406 |
| Business Practice Address: | 1468 N Mustang Rd Mustang, OK - 730640000 |
| Business Phone Number: | 4053761800 |
| Business Fax Number: | 4053761856 |
| Mailing Address: | Po Box 960033, OKLAHOMA CITY |
| State: | OK |
| Postal Code: | 731960033 |
| Phone Number: | 5805481367 |
| Fax Number: | 5805481583 |
| NPI Enumeration Date: | 02/26/2007 |
| NPI Last Update Date: | 05/13/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363AM0700X |
| License Number: | 1406 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OK |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Physician Assistant |
| Taxonomy Specialization: | Medical |
| Taxonomy Definition: | |