Provider Demographics
NPI:1063486280
Name:KECK, TANYA M (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:TANYA
Middle Name:M
Last Name:KECK
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5031 SW 29TH STREET
Mailing Address - Street 2:ACCESS MEDICAL CENTER
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73179
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:16205 N PENNSYLVANIA AVE
Practice Address - Street 2:ACCESS MEDICAL CENTERS
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013
Practice Address - Country:US
Practice Address - Phone:405-705-5700
Practice Address - Fax:405-705-5698
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
OK1834363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant