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General NPI Number Information
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NPI Number | 1003188962
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Entity Type | Individual
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Provider Name | LESTER KEATHLEY RN
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Gender | Male
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Dates
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Enumeration Date | 02/07/2012
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Last Update Date | 08/18/2020
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Provider Practice Location Address
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Address Line | 700 N MAIN ST
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City | GORE
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State | OK
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Zip | 74435-2013
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Country | US
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Telephone | 918-571-2369
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Fax |
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Provider Business Mailing Address
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Address Line | 109 8TH STREET
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City | GORE
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State | OK
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Zip | 74435
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Country | US
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Telephone | 918-571-2369
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 103738
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License Number State | OK
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