Provider Demographics
NPI:1144461518
Name:KEYS FAMILY HEALTH CLINIC
Entity type:Organization
Organization Name:KEYS FAMILY HEALTH CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:EUGENE
Authorized Official - Last Name:COOKSON
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:918-931-1115
Mailing Address - Street 1:26251 HWY 82 SUITE 1
Mailing Address - Street 2:
Mailing Address - City:PARK HILL
Mailing Address - State:OK
Mailing Address - Zip Code:74441
Mailing Address - Country:US
Mailing Address - Phone:918-207-0667
Mailing Address - Fax:918-207-0683
Practice Address - Street 1:26251 HWY 82 SUITE 1
Practice Address - Street 2:
Practice Address - City:PARK HILL
Practice Address - State:OK
Practice Address - Zip Code:74451
Practice Address - Country:US
Practice Address - Phone:918-207-0667
Practice Address - Fax:918-207-0683
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-16
Last Update Date:2010-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0068390363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200117240AMedicaid
OK6422970001Medicare NSC
OK200117240AMedicaid