Provider Demographics
NPI:1588822472
Name:GASKE, KELLE DAWN (APRN, CCNS-P, CDE)
Entity Type:Individual
Prefix:MRS
First Name:KELLE
Middle Name:DAWN
Last Name:GASKE
Suffix:
Gender:F
Credentials:APRN, CCNS-P, CDE
Other - Prefix:MRS
Other - First Name:KELLE
Other - Middle Name:DAWN
Other - Last Name:OVERAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN, CCNS-P
Mailing Address - Street 1:1200 N PHILLIPS AVE STE D
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73104-4600
Mailing Address - Country:US
Mailing Address - Phone:405-271-6764
Mailing Address - Fax:405-271-3093
Practice Address - Street 1:1200 N PHILLIPS AVE STE 4500
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73104-4600
Practice Address - Country:US
Practice Address - Phone:405-271-6764
Practice Address - Fax:405-271-3093
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-28
Last Update Date:2017-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0068098364SP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK1588822472Medicaid