Healthcare Provider Details

I. General information

NPI: 1578230074
Provider Name (Legal Business Name): REAGAN MALONE KELLER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2021
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

825 NE 10TH ST # 2E
OKLAHOMA CITY OK
73104-5417
US

IV. Provider business mailing address

1200 CHILDRENS AVE FL 11
OKLAHOMA CITY OK
73104-4637
US

V. Phone/Fax

Practice location:
  • Phone: 405-271-7001
  • Fax: 405-271-7034
Mailing address:
  • Phone: 405-764-8066
  • Fax: 405-271-1001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5176
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: