# SUPREME HEALTHCARE PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1326631862
- **Authorized official:** MRS. KANDY KAY KEENEY (MANAGER)
- **Authorized official phone:** (918) 845-5498

## Contact information

- **Practice address:** 4619 S HARVARD AVE STE 100, TULSA, OK 74135-2921
- **Practice address phone:** (918) 619-9441
- **Practice address fax:** (918) 619-9442
- **Mailing address:** 9521 RIVERSIDE PKWY STE B, TULSA, OK 74137-7422
- **Mailing address phone:** (918) 845-5498

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 02/16/2021
- **Last updated:** 12/15/2021