Individual
DR. KELLIE DAWN VANTUYL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
30011 E STATE HIGHWAY 51, COWETA, OK 74429-7681
(918) 486-2161
(918) 486-3135
Mailing address
6600 S YALE AVE, SUITE 1400, TULSA, OK 74136-3347
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
5137
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200401090A
—
OK
Enumeration date
08/03/2011
Last updated
03/20/2024
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