Individual
MRS. ELENA MARIE KETNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
3401 W GORE BLVD, LAWTON, OK 73505-6332
(580) 355-8620
Mailing address
3401 W GORE BLVD, LAWTON, OK 73505-6332
(580) 355-8620
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
363LF0000X
Family Nurse Practitioner
Primary
207300
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1497179543
—
OK
Enumeration date
02/10/2014
Last updated
04/19/2022
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