Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0000X | Nurse Practitioner - Neonatal | 101434 | OK |
N | 363LN0000X | Nurse Practitioner - Neonatal | 2008019868 | MO |
NPI | 1174890636 |
---|---|
Provider Name | Mrs. Molly Mckeon |
First Address | Tulsa, OK 74104-4012 |
Second Address | Tulsa, OK 74104-4012 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/11/2011 |
Last Update Date | 28/11/2011 |