Healthcare Provider Details

I. General information

NPI: 1245145556
Provider Name (Legal Business Name): KELSIE MAE SCOTT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2026
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

927 W SPRINGDALE AVE
SAPULPA OK
74066-3851
US

IV. Provider business mailing address

927 W SPRINGDALE AVE
SAPULPA OK
74066-3851
US

V. Phone/Fax

Practice location:
  • Phone: 539-432-3965
  • Fax:
Mailing address:
  • Phone: 539-432-3965
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: