Healthcare Provider Details

I. General information

NPI: 1356905988
Provider Name (Legal Business Name): KEELY REBECCA NUNNALLY NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/29/2019
Last Update Date: 12/31/2025
Certification Date: 12/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2701 W UNIVERSITY BLVD
DURANT OK
74701-2997
US

IV. Provider business mailing address

201 SUNNYMEADOW DR
DURANT OK
74701-4540
US

V. Phone/Fax

Practice location:
  • Phone: 580-775-4559
  • Fax:
Mailing address:
  • Phone: 580-775-4559
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number93441
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: