Healthcare Provider Details

I. General information

NPI: 1013189406
Provider Name (Legal Business Name): PATRICIA A. KEARNEY RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/26/2008
Last Update Date: 04/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

619 N MAIN ST
MUSKOGEE OK
74401-4431
US

IV. Provider business mailing address

2802 GEORGIA AVE
MUSKOGEE OK
74403-7636
US

V. Phone/Fax

Practice location:
  • Phone: 918-682-8407
  • Fax: 918-687-0976
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR0071769
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: