Provider Demographics
NPI:1083903728
Name:BOECKMAN, CELESTE A
Entity Type:Individual
Prefix:
First Name:CELESTE
Middle Name:A
Last Name:BOECKMAN
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 1:4300 W MEMORIAL RD
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73120-8304
Mailing Address - Country:US
Mailing Address - Phone:405-752-3962
Mailing Address - Fax:405-752-3963
Practice Address - Street 1:13901 MCAULEY BLVD STE 303
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73134-8704
Practice Address - Country:US
Practice Address - Phone:405-748-5806
Practice Address - Fax:405-752-3963
Is Sole Proprietor?:No
Enumeration Date:2011-04-04
Last Update Date:2022-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5186207RN0300X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology