Kelly, Edward Leslie
Kelly, Edward Leslie is an individual health care provider with primary practice located at 1300 E Center St , Provo UT 84606-3554. He recently has 4 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Forensic Psychiatry, Allopathic & Osteopathic Physicians / Psychiatry, Allopathic & Osteopathic Physicians / Child & Adolescent Psychiatry, Allopathic & Osteopathic Physicians / Geriatric Psychiatry. Allopathic & Osteopathic Physicians / Psychiatry is his primary health care specialty. Kelly, Edward Leslie can be contacted via phone (801) 344-4400.Contact Information
Primary practice address
1300 E Center St
Provo UT 84606-3554
Phone: (801) 344-4400
Fax: (801) 344-4225
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Forensic Psychiatry | 2084F0202X | 26951 | Nebraska |
| Allopathic & Osteopathic Physicians / Forensic Psychiatry | 2084F0202X | 42929 | Minnesota |
| Allopathic & Osteopathic Physicians / Psychiatry | 2084P0800X | 26951 | Nebraska |
| Allopathic & Osteopathic Physicians / Child & Adolescent Psychiatry | 2084P0804X | MD00040860 | Washington |
| Allopathic & Osteopathic Physicians / Psychiatry | 2084P0800X | MD00040860 | Washington |
| Allopathic & Osteopathic Physicians / Geriatric Psychiatry | 2084P0805X | MD00040860 | Washington |
| Allopathic & Osteopathic Physicians / Forensic Psychiatry | 2084F0202X | MD00040860 | Washington |
Profile Details
| NPI number | 1013995471 |
|---|---|
| LBN Legal business name | Kelly, Edward Leslie |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jan 5th, 2006 |
| Last updated | Jul 2nd, 2020 - about 4 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1013995471 | NPPES |
| Washington | MEDICAID | 1013995471 |
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