Healthcare Provider Details

I. General information

NPI: 1144279258
Provider Name (Legal Business Name): JENNIFER KECK GILBOW ARNP RN DNP CFNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2006
Last Update Date: 08/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 NW 31ST ST 2ND FLOOR
LAWTON OK
73505-6100
US

IV. Provider business mailing address

PO BOX 785
LAWTON OK
73502-0785
US

V. Phone/Fax

Practice location:
  • Phone: 580-357-3671
  • Fax: 580-357-1256
Mailing address:
  • Phone: 580-357-9984
  • Fax: 580-357-3277

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number101863
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number525840
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: