Healthcare Provider Details

I. General information

NPI: 1750020962
Provider Name (Legal Business Name): KYSHAUNNA KELECIA ADAMS CPRSS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/04/2022
Last Update Date: 06/04/2022
Certification Date: 06/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10326 GREENBRIAR PKWY
OKLAHOMA CITY OK
73159-7643
US

IV. Provider business mailing address

10326 GREENBRIAR PKWY
OKLAHOMA CITY OK
73159-7643
US

V. Phone/Fax

Practice location:
  • Phone: 405-759-3860
  • Fax: 405-378-2468
Mailing address:
  • Phone: 405-759-3860
  • Fax: 405-379-2468

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: