Provider Demographics
NPI:1427271774
Name:SAUNDERS, KELLIE DENISE
Entity type:Individual
Prefix:
First Name:KELLIE
Middle Name:DENISE
Last Name:SAUNDERS
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 1:104 E LONE CHIMNEY
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:OK
Mailing Address - Zip Code:74075-1843
Mailing Address - Country:US
Mailing Address - Phone:405-408-8984
Mailing Address - Fax:
Practice Address - Street 1:1015 HILLSIDE DR
Practice Address - Street 2:
Practice Address - City:PERRY
Practice Address - State:OK
Practice Address - Zip Code:73077-7013
Practice Address - Country:US
Practice Address - Phone:580-336-3436
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide