Healthcare Provider Details

I. General information

NPI: 1265019863
Provider Name (Legal Business Name): KELLEY MARIE HARRIS DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2021
Last Update Date: 05/01/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 S WHEELING AVE STE 510
TULSA OK
74104-5642
US

IV. Provider business mailing address

2000 S WHEELING AVE STE 510
TULSA OK
74104-5642
US

V. Phone/Fax

Practice location:
  • Phone: 918-747-5200
  • Fax: 918-858-0290
Mailing address:
  • Phone: 918-747-5200
  • Fax: 918-858-0290

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number7770
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number7770
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: