Healthcare Provider Details

I. General information

NPI: 1356104129
Provider Name (Legal Business Name): KIERAN MICHAEL DONAHUE PMHNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/05/2024
Last Update Date: 04/03/2026
Certification Date: 04/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

302 N INDEPENDENCE ST STE 408
ENID OK
73701-4097
US

IV. Provider business mailing address

302 N INDEPENDENCE ST STE 408
ENID OK
73701-4097
US

V. Phone/Fax

Practice location:
  • Phone: 580-634-3317
  • Fax: 580-565-1019
Mailing address:
  • Phone: 580-634-3317
  • Fax: 580-565-1019

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number203743
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number203743
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: