Healthcare Provider Details

I. General information

NPI: 1477475754
Provider Name (Legal Business Name): KENNEDY FOREMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2026
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9230 E RENO AVE STE B
MIDWEST CITY OK
73130-3337
US

IV. Provider business mailing address

9230 E RENO AVE STE B
MIDWEST CITY OK
73130-3337
US

V. Phone/Fax

Practice location:
  • Phone: 405-737-4900
  • Fax:
Mailing address:
  • Phone: 405-737-4900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number211996
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: