Organization
KETAMINE OK LLC
Active
Other names
Ketamine OK LLC
Organization subpart
No
Provider details
NPI number
Authorized official
JULIE DUDLEY (PRACTICE MANAGER)
(405) 703-0937
Entity
Organization
Contact information
Practice address
1105 SW 30TH CT, MOORE, OK 73160-2887
(405) 703-0937
(405) 378-2776
Mailing address
1105 SW 30TH CT, MOORE, OK 73160-2887
(405) 703-0937
(405) 378-2776
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
—
—
Other
Enumeration date
03/06/2019
Last updated
03/06/2019
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