Healthcare Provider Details

I. General information

NPI: 1114178134
Provider Name (Legal Business Name): KELLI M BRYAN APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/08/2008
Last Update Date: 02/22/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3261 24TH AVE NW STE 101
NORMAN OK
73069
US

IV. Provider business mailing address

3261 24TH AVE NW STE 101
NORMAN OK
73069
US

V. Phone/Fax

Practice location:
  • Phone: 405-364-6432
  • Fax: 937-438-1291
Mailing address:
  • Phone: 937-297-8999
  • Fax: 937-299-8291

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number10251
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: