Kelly Bacon

NPI #1700844313 in Idabel, Oklahoma

Provider Information

NPI Number
1700844313
Entity Type
Individual
Name
Kelly Bacon
Gender
Not Specified
Sole Proprietor
No
Primary Specialty
Nurse Anesthetist, Certified Registered
Enumeration Date
May 3, 2006
Last Updated
Oct 26, 2021

Practice Location

Address
1301 E LINCOLN RD
City
Idabel
ZIP Code
74745-7300
Phone
(580) 286-7623

Specialties & Taxonomy Codes

Specialty
Anesthesiologist Assistant
Nurse Anesthetist, Certified Registered

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Organizations

Provider Name
Mccurtain Memorial Medical Management, Inc.

Part of Mccurtain Memorial Medical Management, Inc.

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