Healthcare Provider Details

I. General information

NPI: 1699104232
Provider Name (Legal Business Name): KEY HEALTH INSTITUTE OF EDMOND, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/04/2013
Last Update Date: 06/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14701 N KELLEY AVE
EDMOND OK
73013-3814
US

IV. Provider business mailing address

236 NW 62ND ST
OKLAHOMA CITY OK
73118-7422
US

V. Phone/Fax

Practice location:
  • Phone: 405-607-5920
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateOK
# 3
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number StateOK

VIII. Authorized Official

Name: DR. AUDRA G FOX
Title or Position: MANAGER
Credential: M.D.
Phone: 405-607-5920