=====================================================
General NPI Number Information
=====================================================
NPI Number | 1497484760
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KEYANNA RENEE RAWLINS FNP-BC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/09/2022
-----------------------------------------------------
Last Update Date | 03/06/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2407 W WRANGLER BLVD STE B
-----------------------------------------------------
City | SEMINOLE
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 74868-1917
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 405-303-2012
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6608 N WESTERN AVE # 1605
-----------------------------------------------------
City | OKLAHOMA CITY
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 73116-7326
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 877-706-6631
-----------------------------------------------------
Fax | 405-289-6782
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 860317
-----------------------------------------------------
License Number State | NV
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 206397
-----------------------------------------------------
License Number State | OK
-----------------------------------------------------