Provider Demographics
NPI:1104088517
Name:MERVELDT, KAELIN COLLEEN (MD)
Entity type:Individual
Prefix:DR
First Name:KAELIN
Middle Name:COLLEEN
Last Name:MERVELDT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:KAELIN
Other - Middle Name:COLLEEN
Other - Last Name:VOLPINI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:13901 MCAULEY BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73134-8700
Mailing Address - Country:US
Mailing Address - Phone:405-748-5800
Mailing Address - Fax:
Practice Address - Street 1:13901 MCAULEY BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73134-8700
Practice Address - Country:US
Practice Address - Phone:405-748-5800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-26
Last Update Date:2013-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125.055161207R00000X
OK29625207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine