Provider Demographics
NPI:1184291767
Name:MARTIN, KELLEY (APRN-CNP)
Entity type:Individual
Prefix:
First Name:KELLEY
Middle Name:
Last Name:MARTIN
Suffix:
Gender:F
Credentials:APRN-CNP
Other - Prefix:
Other - First Name:KELLEY
Other - Middle Name:
Other - Last Name:HOOD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:2501 W 66TH PL
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74132-1379
Mailing Address - Country:US
Mailing Address - Phone:919-710-6429
Mailing Address - Fax:
Practice Address - Street 1:421 STONE WOOD DR
Practice Address - Street 2:
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74012-1026
Practice Address - Country:US
Practice Address - Phone:918-872-8822
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-10
Last Update Date:2024-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0117418163W00000X
OK202627363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse