Healthcare Provider Details

I. General information

NPI: 1447409206
Provider Name (Legal Business Name): KERRI LEE ELLIS A.R.N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2008
Last Update Date: 09/30/2021
Certification Date: 09/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 E MAIN ST
BEGGS OK
74421
US

IV. Provider business mailing address

PO BOX 478 103 E MAIN ST
BEGGS OK
74421-0478
US

V. Phone/Fax

Practice location:
  • Phone: 918-267-7000
  • Fax: 918-267-7077
Mailing address:
  • Phone: 918-367-0010
  • Fax: 918-703-4713

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number53535
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: