=====================================================
General NPI Number Information
=====================================================
NPI Number | 1225833569
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | HANNAH JOY KEYLADA APRN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/19/2025
-----------------------------------------------------
Last Update Date | 10/22/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1919 S WHEELING AVE STE 504
-----------------------------------------------------
City | TULSA
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 74104-5634
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 918-748-7532
-----------------------------------------------------
Fax | 918-710-3068
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1923 S UTICA AVE CREDENTIALING OFC, GROUND FL
-----------------------------------------------------
City | TULSA
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 74104-6520
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 918-403-7065
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number | 209722
-----------------------------------------------------
License Number State | OK
-----------------------------------------------------