Healthcare Provider Details

I. General information

NPI: 1649956723
Provider Name (Legal Business Name): TIMOTHY AARON KEETON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/23/2023
Last Update Date: 06/23/2023
Certification Date: 06/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6333 E SKELLY DR
TULSA OK
74135-6106
US

IV. Provider business mailing address

220 S 3RD AVE
STROUD OK
74079-4612
US

V. Phone/Fax

Practice location:
  • Phone: 918-779-7216
  • Fax:
Mailing address:
  • Phone: 918-290-1871
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: