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Individual

KELLI LOVELACE

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
M.D.

Contact information

Practice address
2121 E 21ST ST, TULSA, OK 74114-1409
(918) 749-2261
Mailing address
PO BOX 52588, TULSA, OK 74152-0588
(918) 749-2261

Taxonomy

Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
23483
OK

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
200124080A
OK
01
23483
MEDICAL LICENSE
OK
01
7255935
AETNA HMO
01
P00444180
RAILROAD MEDICARE
Enumeration date
02/06/2007
Last updated
04/13/2026
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