Provider Demographics
NPI:1386098325
Name:CODY, KELSEA NICOLE
Entity type:Individual
Prefix:MS
First Name:KELSEA
Middle Name:NICOLE
Last Name:CODY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2413 N STAR DR
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:OK
Mailing Address - Zip Code:74075-2656
Mailing Address - Country:US
Mailing Address - Phone:405-589-7172
Mailing Address - Fax:
Practice Address - Street 1:2413 N STAR DR
Practice Address - Street 2:
Practice Address - City:STILLWATER
Practice Address - State:OK
Practice Address - Zip Code:74075-2656
Practice Address - Country:US
Practice Address - Phone:405-589-7172
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-15
Last Update Date:2016-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator