Healthcare Provider Details

I. General information

NPI: 1740700152
Provider Name (Legal Business Name): KELBY LEE SUNARTO APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/27/2017
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 NW 56TH ST STE 202
OKLAHOMA CITY OK
73112-4401
US

IV. Provider business mailing address

3300 NW 56TH ST STE 202
OKLAHOMA CITY OK
73112-4401
US

V. Phone/Fax

Practice location:
  • Phone: 405-702-9000
  • Fax: 405-702-9090
Mailing address:
  • Phone: 405-702-9000
  • Fax: 405-702-9090

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number108296
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number108296
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: