Provider Demographics
NPI:1851158810
Name:KING, KELCEY YANEZ (DNP, APRN, CPNP-PC)
Entity Type:Individual
Prefix:
First Name:KELCEY
Middle Name:YANEZ
Last Name:KING
Suffix:
Gender:F
Credentials:DNP, APRN, CPNP-PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29341 HAMPTON DR
Mailing Address - Street 2:
Mailing Address - City:BLANCHARD
Mailing Address - State:OK
Mailing Address - Zip Code:73010-7039
Mailing Address - Country:US
Mailing Address - Phone:580-668-0806
Mailing Address - Fax:
Practice Address - Street 1:700 WALL ST
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73069-6360
Practice Address - Country:US
Practice Address - Phone:405-360-7337
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-05
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK217037363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics