Healthcare Provider Details

I. General information

NPI: 1467172783
Provider Name (Legal Business Name): BAILEY KEESEE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2022
Last Update Date: 03/21/2023
Certification Date: 03/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2010 BOREN BLVD
SEMINOLE OK
74868-2050
US

IV. Provider business mailing address

2010 BOREN BLVD
SEMINOLE OK
74868-2050
US

V. Phone/Fax

Practice location:
  • Phone: 405-382-4507
  • Fax:
Mailing address:
  • Phone: 405-382-4507
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number204023
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: