Individual
KELLY JANELL PETREE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
9228 S MINGO RD STE 101&103, TULSA, OK 74133-5718
(405) 378-2727
Mailing address
9228 S MINGO RD STE 101&103, TULSA, OK 74133-5718
(405) 378-2727
(918) 518-7258
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
2020000885
MO
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
212074
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
420080198
—
MO
Enumeration date
01/10/2020
Last updated
04/19/2023
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