Provider Demographics
NPI:1003188962
Name:KEATHLEY, LESTER (RN)
Entity Type:Individual
Prefix:
First Name:LESTER
Middle Name:
Last Name:KEATHLEY
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 8TH STREET
Mailing Address - Street 2:
Mailing Address - City:GORE
Mailing Address - State:OK
Mailing Address - Zip Code:74435
Mailing Address - Country:US
Mailing Address - Phone:918-571-2369
Mailing Address - Fax:
Practice Address - Street 1:700 N MAIN ST
Practice Address - Street 2:
Practice Address - City:GORE
Practice Address - State:OK
Practice Address - Zip Code:74435-2013
Practice Address - Country:US
Practice Address - Phone:918-571-2369
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-07
Last Update Date:2020-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK103738363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily