MEDICARE: KAIRIE SWIFT CNP-FAMILY

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	363LF0000X	Family Nurse Practitioner	95055	OK

General Provider Information

NPI Number	:	1952939340
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAIRIE SWIFT CNP-FAMILY

Provider Business Mailing Address
First Line	:	1008 E ELM ST
Second Line	:
City	:	STROUD
State	:	OK
Zip	:	74079-7361
Country	:	US
Telephone Number	:	918-806-8656
Fax Number	:

Provider Business Practice Location Address
First Line	:	3321 S YALE AVE
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74135-8011
Country	:	US
Telephone Number	:	918-629-9393
Fax Number	:

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

Provider Enumeration Date	:	03/31/2020
Last Update Date	:	03/31/2020

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