Individual
KEELY MCGOUGH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DNP
Contact information
Practice address
4000 W RENO AVE, OKLAHOMA CITY, OK 73107-6632
(405) 632-6688
Mailing address
3000 N GRAND BLVD, OKLAHOMA CITY, OK 73107-1818
(405) 632-6688
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
G431360
CA
363LF0000X
Family Nurse Practitioner
Primary
R0117106
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1801808357
—
CA
01
—
22927742
NCSBN
OK
05
—
770172743
—
CA
01
—
R0117106
APRN-CNP LICENSE
OK
Enumeration date
10/17/2020
Last updated
09/30/2021
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