Basic Information
| Provider Information | |||||||||
| NPI: | 1033319439 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | O'KELLY PRIDDY | ||||||||
| FirstName: | COLLEEN | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | MD | ||||||||
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| OtherLastName: | O'KELLY | ||||||||
| OtherFirstName: | COLLEEN | ||||||||
| OtherMiddleName: | M | ||||||||
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| OtherCredential: | MD | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 33 LEWIS RD | ||||||||
| Address2: | 2ND FLOOR | ||||||||
| City: | BINGHAMTON | ||||||||
| State: | NY | ||||||||
| PostalCode: | 139051048 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 1325 E CHURCH ST STE 202 | ||||||||
| Address2: | |||||||||
| City: | SANTA MARIA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 934545915 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8053463456 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/23/2007 | ||||||||
| LastUpdateDate: | 04/06/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/06/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | ML20008982 | WA | N | Allopathic & Osteopathic Physicians | Surgery | 208600000X | MD60096012 | WA | N | Allopathic & Osteopathic Physicians | Surgery | 208600000X | 283827 | NY | N | Allopathic & Osteopathic Physicians | Surgery | 208600000X | A135991 | CA | Y | Allopathic & Osteopathic Physicians | Surgery |
No ID Information.