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General NPI Number Information
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NPI Number | 1922000280
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Entity Type | Individual
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Provider Name | MADELYN M KECK A.R.N.P.
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Gender | Female
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Dates
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Enumeration Date | 06/01/2005
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Last Update Date | 10/08/2015
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Provider Practice Location Address
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Address Line | 302 N INDEPENDENCE STREET SUITE 700
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City | ENID
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State | OK
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Zip | 73701-4046
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Country | US
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Telephone | 580-249-3066
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Fax | 580-234-5385
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Provider Business Mailing Address
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Address Line | PO BOX 844737 ATTN: IPM CREDENTIALING
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City | DALLAS
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State | TX
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Zip | 75284-4737
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Country | US
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Telephone | 903-416-1726
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Fax | 903-416-1701
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | R0039619
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License Number State | OK
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