Provider Demographics
NPI:1023687381
Name:TEMPLETON, KELLY SUZANNE (CC)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:SUZANNE
Last Name:TEMPLETON
Suffix:
Gender:F
Credentials:CC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1825 E MAIN ST APT 305
Mailing Address - Street 2:
Mailing Address - City:PAWHUSKA
Mailing Address - State:OK
Mailing Address - Zip Code:74056-2514
Mailing Address - Country:US
Mailing Address - Phone:918-625-5144
Mailing Address - Fax:
Practice Address - Street 1:1825 E MAIN ST APT 305
Practice Address - Street 2:
Practice Address - City:PAWHUSKA
Practice Address - State:OK
Practice Address - Zip Code:74056-2514
Practice Address - Country:US
Practice Address - Phone:918-625-5144
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-22
Last Update Date:2021-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator