Healthcare Provider Details

I. General information

NPI: 1447896147
Provider Name (Legal Business Name): KELLY LESLIE APRN-FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/18/2019
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1327 OKLAHOMA AVE
WOODWARD OK
73801-4454
US

IV. Provider business mailing address

1327 OKLAHOMA AVE
WOODWARD OK
73801-4454
US

V. Phone/Fax

Practice location:
  • Phone: 580-254-2377
  • Fax: 580-254-2388
Mailing address:
  • Phone: 580-254-2377
  • Fax: 580-254-2388

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024182771
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number228703
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: