Healthcare Provider Details

I. General information

NPI: 1396453197
Provider Name (Legal Business Name): JARED NILE SETH KECK PMHNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/10/2022
Last Update Date: 05/22/2025
Certification Date: 05/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21374 BRYANT AVE
PURCELL OK
73080-4441
US

IV. Provider business mailing address

21374 BRYANT AVE
PURCELL OK
73080-4441
US

V. Phone/Fax

Practice location:
  • Phone: 405-990-8624
  • Fax:
Mailing address:
  • Phone: 405-990-8624
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number210944
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: