Healthcare Provider Details

I. General information

NPI: 1437340528
Provider Name (Legal Business Name): JAMES RILEY KELLER PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: JIM R KELLER PHD

II. Dates (important events)

Enumeration Date: 08/05/2007
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

921 NE 13TH ST
OKLAHOMA CITY OK
73104-5007
US

IV. Provider business mailing address

PO BOX 7083
EDMOND OK
73083-7083
US

V. Phone/Fax

Practice location:
  • Phone: 405-302-1500
  • Fax:
Mailing address:
  • Phone: 405-760-0997
  • Fax: 866-877-1135

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number854
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: