MEDICARE: MS. KELLIE J WARD

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
1	163WG0600X	Gerontology Registered Nurse	82856	OK

General Provider Information

NPI Number	:	1386270312
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KELLIE J WARD

Provider Business Mailing Address
First Line	:	2513 W PARK PL
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73107-5431
Country	:	US
Telephone Number	:	405-558-1835
Fax Number	:

Provider Business Practice Location Address
First Line	:	225 SW 35TH ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73109-6807
Country	:	US
Telephone Number	:	405-631-7444
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/22/2020
Last Update Date	:	03/22/2020

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