Healthcare Provider Details

I. General information

NPI: 1275662058
Provider Name (Legal Business Name): KEELY WHEELER D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/05/2007
Last Update Date: 01/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5200 S YALE AVE SUITE 402
TULSA OK
74135-7451
US

IV. Provider business mailing address

5200 S YALE AVE SUITE 402
TULSA OK
74135-7451
US

V. Phone/Fax

Practice location:
  • Phone: 918-609-0755
  • Fax:
Mailing address:
  • Phone: 918-609-0755
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberDO.000230
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberDO.000230
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: