Healthcare Provider Details

I. General information

NPI: 1225708167
Provider Name (Legal Business Name): VICKIE L KEYS CERTIFIED PRSS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/13/2021
Last Update Date: 02/15/2022
Certification Date: 02/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2508 E 71ST ST STE C
TULSA OK
74136-5572
US

IV. Provider business mailing address

PO BOX 690184
TULSA OK
74169-0184
US

V. Phone/Fax

Practice location:
  • Phone: 918-794-6570
  • Fax: 918-340-5189
Mailing address:
  • Phone: 539-367-1677
  • Fax: 539-367-1991

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: