Healthcare Provider Details

I. General information

NPI: 1679249080
Provider Name (Legal Business Name): KATLYN BUERKER APRN-CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2021
Last Update Date: 11/08/2021
Certification Date: 11/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32208 E 142ND ST S
COWETA OK
74429-5744
US

IV. Provider business mailing address

206 E BLUE STARR DR
CLAREMORE OK
74017-4223
US

V. Phone/Fax

Practice location:
  • Phone: 580-271-0303
  • Fax:
Mailing address:
  • Phone: 918-341-8100
  • Fax: 918-341-8139

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number205139
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: