MEDICARE: KELLEY MARTIN APRN-CNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	R0117418	OK
2	363L00000X	Nurse Practitioner	202627	OK
3	363LA2100X	Acute Care Nurse Practitioner	202627	OK

General Provider Information

NPI Number	:	1184291767
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLEY MARTIN APRN-CNP

Provider Business Mailing Address
First Line	:	6600 S YALE AVE STE 1400
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74136-3331
Country	:	US
Telephone Number	:	918-499-4855
Fax Number	:	918-488-6098

Provider Business Practice Location Address
First Line	:	6151 S YALE AVE STE 1304
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74136-1907
Country	:	US
Telephone Number	:	918-502-3200
Fax Number	:	918-502-3205

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/10/2021
Last Update Date	:	12/04/2025

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Directions to “ KELLEY MARTIN APRN-CNP” Practice Location

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