MEDICARE: MRS. AMANDA RAE KEMP RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WC1500X	Community Health Registered Nurse	R0119028	OK

General Provider Information

NPI Number	:	1336921907
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. AMANDA RAE KEMP RN

Provider Business Mailing Address
First Line	:	3401 CHESTERFIELD PL
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73179-6018
Country	:	US
Telephone Number	:	405-824-2737
Fax Number	:

Provider Business Practice Location Address
First Line	:	2460 NW 39TH ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73112-8956
Country	:	US
Telephone Number	:	405-948-1770
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/18/2023
Last Update Date	:	10/18/2023

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