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General NPI Number Information
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NPI Number | 1447924980
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Entity Type | Individual
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Provider Name | KELLI ANN ANDERSON APRN, CNP
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Gender | Female
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Dates
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Enumeration Date | 08/08/2021
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Last Update Date | 08/30/2021
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Provider Practice Location Address
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Address Line | 8803 S 101ST EAST AVE
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City | TULSA
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State | OK
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Zip | 74133-5726
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Country | US
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Telephone | 918-579-3270
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Fax |
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Provider Business Mailing Address
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Address Line | 127 W 116TH ST
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City | JENKS
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State | OK
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Zip | 74037-3679
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Country | US
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Telephone | 918-605-5242
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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 | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 201707
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License Number State | OK
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