Healthcare Provider Details

I. General information

NPI: 1427271774
Provider Name (Legal Business Name): KELLIE DENISE SAUNDERS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/11/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1015 HILLSIDE DR
PERRY OK
73077-7013
US

IV. Provider business mailing address

104 E LONE CHIMNEY
STILLWATER OK
74075-1843
US

V. Phone/Fax

Practice location:
  • Phone: 580-336-3436
  • Fax:
Mailing address:
  • Phone: 405-408-8984
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: