Individual
KEITH VINCENT ELLINGSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PMHNP
Contact information
Practice address
921 NE 13TH ST, OKLAHOMA CITY, OK 73104-5007
(405) 456-1000
Mailing address
4400 N LINCOLN BLVD, OKLAHOMA CITY, OK 73105-5104
(405) 424-7711
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
—
—
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
209482
OK
Other
Enumeration date
08/09/2016
Last updated
07/27/2022
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