Provider Demographics
NPI:1396453197
Name:KECK, JARED NILE SETH (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:JARED
Middle Name:NILE SETH
Last Name:KECK
Suffix:
Gender:M
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21374 BRYANT AVE
Mailing Address - Street 2:
Mailing Address - City:PURCELL
Mailing Address - State:OK
Mailing Address - Zip Code:73080-4441
Mailing Address - Country:US
Mailing Address - Phone:405-990-8624
Mailing Address - Fax:
Practice Address - Street 1:21374 BRYANT AVE
Practice Address - Street 2:
Practice Address - City:PURCELL
Practice Address - State:OK
Practice Address - Zip Code:73080-4441
Practice Address - Country:US
Practice Address - Phone:405-990-8624
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-10
Last Update Date:2025-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK210944363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty