Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | R0048419 | OK |
NPI | 1003037516 |
---|---|
Provider Name | Mrs. Judy Kay Kellogg |
First Address | Oklahoma City, OK 73139-2544 |
Second Address | Oklahoma City, OK 73139-2544 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/05/2007 |
Last Update Date | 29/03/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100174990A | (05) | OK |