Healthcare Provider Details

I. General information

NPI: 1679382055
Provider Name (Legal Business Name): KELI WOODARD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/31/2024
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 S PENN AVE
BARTLESVILLE OK
74003-3847
US

IV. Provider business mailing address

557 SE GREYSTONE AVE
BARTLESVILLE OK
74006-8421
US

V. Phone/Fax

Practice location:
  • Phone: 844-458-2100
  • Fax:
Mailing address:
  • Phone: 539-240-5671
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number90521
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: