Provider Demographics
NPI:1780285817
Name:SPURLOCK, KELLIE DAWN (PHARMD)
Entity type:Individual
Prefix:DR
First Name:KELLIE
Middle Name:DAWN
Last Name:SPURLOCK
Suffix:
Gender:
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 SW 89TH ST STE 200
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73139-8535
Mailing Address - Country:US
Mailing Address - Phone:405-761-2762
Mailing Address - Fax:877-909-7647
Practice Address - Street 1:8 SW 89TH ST STE 200
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73139-8535
Practice Address - Country:US
Practice Address - Phone:405-761-2762
Practice Address - Fax:877-909-7647
Is Sole Proprietor?:No
Enumeration Date:2020-11-04
Last Update Date:2025-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX54049183500000X
OK13529183500000X, 1835I0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835I0206XPharmacy Service ProvidersPharmacistInfectious Diseases
No183500000XPharmacy Service ProvidersPharmacist