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General NPI Number Information
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NPI Number | 1023742632
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Entity Type | Individual
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Provider Name | KELLI REBECCA LAWRENCE
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Gender | Female
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Dates
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Enumeration Date | 07/11/2022
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Last Update Date | 01/26/2026
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Provider Practice Location Address
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Address Line | 429728 E 1148 RD
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City | PORUM
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State | OK
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Zip | 74455-5741
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Country | US
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Telephone | 580-618-4591
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Fax |
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Provider Business Mailing Address
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Address Line | 429728 E 1148 RD
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City | PORUM
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State | OK
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Zip | 74455-5741
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Country | US
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Telephone | 580-618-4591
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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 | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | 209447
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License Number State | OK
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