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NPI Code Detail

MEDICARE: KELLEY REBEKAH STUCKEY MSN, APRN-CNP, FNP-C

MEDICARE: KELLEY REBEKAH STUCKEY MSN, APRN-CNP, FNP-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1163W00000XRegistered Nurse113764OK
2363LF0000XFamily Nurse Practitioner204582OK

General Provider Information

NPI Number : 1225618804
Entity Type Code : Individual
Provider Name (Legal Business Name) : KELLEY REBEKAH STUCKEY MSN, APRN-CNP, FNP-C
Provider Business Mailing Address
First Line : 4705 S 129TH EAST AVE
Second Line :
City : TULSA
State : OK
Zip : 74134-7005
Country : US
Telephone Number : 918-994-3471
Fax Number :
Provider Business Practice Location Address
First Line : 4705 S 129TH EAST AVE
Second Line :
City : TULSA
State : OK
Zip : 74134-7005
Country : US
Telephone Number : 833-863-3947
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/08/2021
Last Update Date : 09/19/2021

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