Healthcare Provider Details

I. General information

NPI: 1508841222
Provider Name (Legal Business Name): KELLY M RUDD PHARM.D., BCPS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/15/2005
Last Update Date: 04/17/2025
Certification Date: 04/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 W 17TH ST
TULSA OK
74107-1886
US

IV. Provider business mailing address

34794 S HIGHWAY 82
VINITA OK
74301-7045
US

V. Phone/Fax

Practice location:
  • Phone: 185-618-2399
  • Fax:
Mailing address:
  • Phone: 315-717-3268
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number19713
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number050193
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number19454
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: