Healthcare Provider Details

I. General information

NPI: 1386770246
Provider Name (Legal Business Name): KELLY M DENNIS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/26/2007
Last Update Date: 04/23/2026
Certification Date: 04/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4140 W MEMORIAL RD STE 208
OKLAHOMA CITY OK
73120-8300
US

IV. Provider business mailing address

PO BOX 776084
CHICAGO IL
60677-6084
US

V. Phone/Fax

Practice location:
  • Phone: 405-749-7004
  • Fax: 405-752-3457
Mailing address:
  • Phone: 405-242-4030
  • Fax: 405-242-4031

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number1406
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: