Provider Demographics
NPI:1477588861
Name:PERRY, KEITH D (CRNA)
Entity Type:Individual
Prefix:
First Name:KEITH
Middle Name:D
Last Name:PERRY
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5300 N INDEPENDENCE AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-5556
Mailing Address - Country:US
Mailing Address - Phone:405-717-6800
Mailing Address - Fax:405-717-7964
Practice Address - Street 1:1201 HEALTH CENTER PKWY
Practice Address - Street 2:
Practice Address - City:YUKON
Practice Address - State:OK
Practice Address - Zip Code:73099-6381
Practice Address - Country:US
Practice Address - Phone:405-717-6800
Practice Address - Fax:405-717-7964
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2018-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK48030367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100788300AMedicaid
OKP00376094OtherRR MEDICARE
OK100788300AMedicaid
OK243606204Medicare PIN