Provider Information for 1841429719
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Ms. KELLY L. MATTIS L.P.C.C.
Sex: Female
NPI: 1841429719
Last Updated: 2015-01-29
Certification Date:
Certification Date:
Details
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NPI | 1841429719 | ||||||||||||||||
Enumeration Date | 2009-07-13 | ||||||||||||||||
NPI Type | NPI-1 Individual | ||||||||||||||||
Sole Proprietor | NO | ||||||||||||||||
Status | Active | ||||||||||||||||
Mailing Address | PO BOX 2055 JAMESTOWN, ND 58402-2055 United States Phone: 701-253-6300 | Fax:701-253-6400 | ||||||||||||||||
Primary Practice Address | 520 3RD ST NW JAMESTOWN, ND 58401-2968 United States Phone: 701-253-6300 | Fax:701-253-6400 | ||||||||||||||||
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