Healthcare Provider Details

I. General information

NPI: 1033570494
Provider Name (Legal Business Name): KESHA DYANN ABBANANTO RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KESHA DYANN COSSEY RN

II. Dates (important events)

Enumeration Date: 03/14/2016
Last Update Date: 03/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4913 W RENO AVE
OKLAHOMA CITY OK
73127-6339
US

IV. Provider business mailing address

4913 W RENO AVE
OKLAHOMA CITY OK
73127-6339
US

V. Phone/Fax

Practice location:
  • Phone: 405-948-4900
  • Fax: 405-595-3197
Mailing address:
  • Phone: 405-948-4900
  • Fax: 405-595-3197

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number74188
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: