Provider Demographics
NPI:1053384818
Name:ROSS, KELLY L (DO)
Entity type:Individual
Prefix:DR
First Name:KELLY
Middle Name:L
Last Name:ROSS
Suffix:
Gender:F
Credentials:DO
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Mailing Address - Street 1:2305 SOUTH 65 HIGHWAY
Mailing Address - Street 2:
Mailing Address - City:MARSHALL
Mailing Address - State:MO
Mailing Address - Zip Code:65340-3702
Mailing Address - Country:US
Mailing Address - Phone:660-831-3553
Mailing Address - Fax:660-831-3325
Practice Address - Street 1:2305 SOUTH 65 HIGHWAY
Practice Address - Street 2:
Practice Address - City:MARSHALL
Practice Address - State:MO
Practice Address - Zip Code:65340-3702
Practice Address - Country:US
Practice Address - Phone:660-886-8414
Practice Address - Fax:660-831-3325
Is Sole Proprietor?:No
Enumeration Date:2006-02-10
Last Update Date:2021-08-25
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Provider Licenses
StateLicense IDTaxonomies
MO2005023176207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOP00266071OtherRAIL ROAD MEDICARE
MO207593807Medicaid
MO207593807Medicaid
MOMA1085001Medicare Oscar/Certification
I41324Medicare UPIN