Healthcare Provider Details

I. General information

NPI: 1194417469
Provider Name (Legal Business Name): KELBI LAYNE OGG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/24/2023
Last Update Date: 08/06/2024
Certification Date: 08/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5310 E 31ST ST
TULSA OK
74135-5012
US

IV. Provider business mailing address

8809 N 137TH EAST AVE
OWASSO OK
74055-2060
US

V. Phone/Fax

Practice location:
  • Phone: 918-600-3100
  • Fax:
Mailing address:
  • Phone: 918-319-0674
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: