Provider Demographics
NPI:1699150052
Name:KEESEE, STEPHANIE (APRN-CNP)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:KEESEE
Suffix:
Gender:F
Credentials:APRN-CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 N HINCKLEY ST
Mailing Address - Street 2:
Mailing Address - City:HOLDENVILLE
Mailing Address - State:OK
Mailing Address - Zip Code:74848-5449
Mailing Address - Country:US
Mailing Address - Phone:405-712-5080
Mailing Address - Fax:833-254-2642
Practice Address - Street 1:201 N HINCKLEY ST
Practice Address - Street 2:
Practice Address - City:HOLDENVILLE
Practice Address - State:OK
Practice Address - Zip Code:74848
Practice Address - Country:US
Practice Address - Phone:405-712-5080
Practice Address - Fax:833-254-2642
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-28
Last Update Date:2018-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK83082363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200670850AMedicaid