Healthcare Provider Details

I. General information

NPI: 1710841002
Provider Name (Legal Business Name): KAYE A KELLER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/11/2025
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6735 S 93RD EAST AVE
TULSA OK
74133-2232
US

IV. Provider business mailing address

6735 S 93RD EAST AVE
TULSA OK
74133-2232
US

V. Phone/Fax

Practice location:
  • Phone: 972-849-1161
  • Fax:
Mailing address:
  • Phone: 972-849-1161
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747A0650X
TaxonomyAttendant Care Provider
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: