Individual
KELLY HALLQUIST
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
15003 E 89TH PL N, OWASSO, OK 74055-4883
(918) 812-8874
Mailing address
15003 E 89TH PL N, OWASSO, OK 74055-4883
(918) 812-8874
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
06/28/2019
Last updated
06/28/2019
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