Provider Demographics
NPI:1467497743
Name:RUMMEL, KEITH CHARLES (FNP)
Entity Type:Individual
Prefix:MR
First Name:KEITH
Middle Name:CHARLES
Last Name:RUMMEL
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:DEPT 960390
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73196-0390
Mailing Address - Country:US
Mailing Address - Phone:877-485-4474
Mailing Address - Fax:405-844-1794
Practice Address - Street 1:231 SOUTH COLLINS
Practice Address - Street 2:EMERGENCY DEPT
Practice Address - City:SUNNYVALE
Practice Address - State:TX
Practice Address - Zip Code:75182-4624
Practice Address - Country:US
Practice Address - Phone:972-892-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-19
Last Update Date:2010-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX658261363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX153508010Medicaid
TX153508010Medicaid
TXTXB109781Medicare PIN