Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 6918 | OK |
NPI | 1003336132 |
---|---|
Provider Name | Dr. Kelsey Keoppel |
First Address | Oklahoma City, OK 73112-5555 |
Second Address | Edmond, OK 73034-8696 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/06/2017 |
Last Update Date | 04/08/2020 |