Individual
MRS. KELLY HACKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
750 NE 13TH ST STE 200, OKLAHOMA CITY, OK 73104-5051
(405) 627-1435
(405) 627-1869
Mailing address
750 NE 13TH ST STE 200, P.O. BOX 53188, OKLAHOMA CITY, OK 73104-5051
(405) 627-1435
(405) 627-1869
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
1373
OK
Other
Enumeration date
04/18/2008
Last updated
04/18/2008
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