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Organization

MIND AND BODY MEDICAL CLINIC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
KELLI LEEK APRN-CNS (CO-OWNER)
(405) 285-4755
Entity
Organization

Contact information

Practice address
2216 NW 164TH ST STE A, EDMOND, OK 73013-9078
(405) 285-4755
(405) 215-3760
Mailing address
2216 NW 164TH ST STE A, EDMOND, OK 73013-9078
(405) 285-4755
(405) 215-3760

Taxonomy

Speciality
Code
Description
License number
State
2084A0401X
Addiction Medicine (Psychiatry & Neurology) Physician
2084N0400X
Neurology Physician
Primary
2084P0301X
Brain Injury Medicine (Psychiatry & Neurology) Physician
2084V0102X
Vascular Neurology Physician
364SC0200X
Critical Care Medicine Clinical Nurse Specialist
364SN0800X
Neuroscience Clinical Nurse Specialist

Other

Enumeration date
11/04/2018
Last updated
11/04/2018
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