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Individual
KEITH VINCENT ELLINGSON
Active
Individual
KEITH VINCENT ELLINGSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PMHNP
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
—
NULL
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
209482
OK
Other
Enumeration date
08/09/2016
Last updated
07/27/2022
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