Organization
SUPREME HEALTHCARE PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. KANDY KAY KEENEY (MANAGER)
(918) 845-5498
Entity
Organization
Contact information
Practice address
4619 S HARVARD AVE STE 100, TULSA, OK 74135-2921
(918) 619-9441
(918) 619-9442
Mailing address
9521 RIVERSIDE PKWY STE B, TULSA, OK 74137-7422
(918) 845-5498
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200993730
—
OK
Enumeration date
02/16/2021
Last updated
12/15/2021
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