Individual
KELLI REBECCA LAWRENCE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
429728 E 1148 RD, PORUM, OK 74455-5741
(580) 618-4591
Mailing address
429728 E 1148 RD, PORUM, OK 74455-5741
(580) 618-4591
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
F07220309
OK
363LP2300X
Primary Care Nurse Practitioner
Primary
209447
OK
Other
Enumeration date
07/11/2022
Last updated
01/26/2026
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