Healthcare Provider Details

I. General information

NPI: 1497951685
Provider Name (Legal Business Name): ADRIENNE EMEL KESINGER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2007
Last Update Date: 12/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 SW 119TH ST
OKLAHOMA CITY OK
73170-4908
US

IV. Provider business mailing address

5300 N INDEPENDENCE AVE SUITE 280
OKLAHOMA CITY OK
73112-5556
US

V. Phone/Fax

Practice location:
  • Phone: 405-425-8100
  • Fax: 405-425-8109
Mailing address:
  • Phone: 405-425-8100
  • Fax: 405-425-8109

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number25731
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number25731
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: