Provider Demographics
NPI:1851586721
Name:TUCKER, KEELIE RENEE (MD)
Entity Type:Individual
Prefix:MRS
First Name:KEELIE
Middle Name:RENEE
Last Name:TUCKER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5300 N INDEPENDENCE AVE
Mailing Address - Street 2:280
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-5556
Mailing Address - Country:US
Mailing Address - Phone:580-213-9760
Mailing Address - Fax:580-213-9769
Practice Address - Street 1:620 S MADISON ST
Practice Address - Street 2:SUITE 203
Practice Address - City:ENID
Practice Address - State:OK
Practice Address - Zip Code:73701-7273
Practice Address - Country:US
Practice Address - Phone:580-213-9760
Practice Address - Fax:580-213-9769
Is Sole Proprietor?:No
Enumeration Date:2007-09-12
Last Update Date:2018-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP0146207V00000X
OK28642207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200345390AMedicaid
OK299128YKW9Medicare PIN