Healthcare Provider Details

I. General information

NPI: 1144029448
Provider Name (Legal Business Name): KYLEE RAELYN RAMIREZ APRN-CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/10/2025
Last Update Date: 07/21/2025
Certification Date: 07/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 S PARK LN STE 210
ALTUS OK
73521-5757
US

IV. Provider business mailing address

1200 E PECAN ST
ALTUS OK
73521-6192
US

V. Phone/Fax

Practice location:
  • Phone: 580-379-6650
  • Fax: 580-379-6659
Mailing address:
  • Phone: 580-379-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number222374
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number222374
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: