Healthcare Provider Details

I. General information

NPI: 1316622103
Provider Name (Legal Business Name): ALLEGRA KNIGHT KEELING
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALLEGRA KNIGHT

II. Dates (important events)

Enumeration Date: 06/19/2023
Last Update Date: 06/18/2025
Certification Date: 06/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 SE 4TH ST
MOORE OK
73160-7329
US

IV. Provider business mailing address

1400 SE 4TH ST
MOORE OK
73160-7329
US

V. Phone/Fax

Practice location:
  • Phone: 405-837-1033
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number11551
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: