Provider Demographics
NPI:1023156791
Name:KEITH, DEBRA (PA)
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:
Last Name:KEITH
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:237 S LOCUST
Mailing Address - Street 2:
Mailing Address - City:NOWATA
Mailing Address - State:OK
Mailing Address - Zip Code:74048
Mailing Address - Country:US
Mailing Address - Phone:918-273-3102
Mailing Address - Fax:
Practice Address - Street 1:237 S LOCUST
Practice Address - Street 2:
Practice Address - City:NOWATA
Practice Address - State:OK
Practice Address - Zip Code:74048
Practice Address - Country:US
Practice Address - Phone:918-273-3102
Practice Address - Fax:918-273-5490
Is Sole Proprietor?:No
Enumeration Date:2007-02-02
Last Update Date:2015-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK16056363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant