Individual
MADELYN M KECK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
A.R.N.P.
Contact information
Practice address
302 N INDEPENDENCE STREET, SUITE 700, ENID, OK 73701-4046
(580) 249-3066
(580) 234-5385
Mailing address
PO BOX 844737, ATTN: IPM CREDENTIALING, DALLAS, TX 75284-4737
(903) 416-1726
(903) 416-1701
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
R0039619
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100088110A
—
OK
01
—
444342284001
BLUE CROSS
OK
01
—
500017031
RAILROAD MEDICARE
OK
Enumeration date
06/01/2005
Last updated
10/08/2015
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