Healthcare Provider Details

I. General information

NPI: 1215451281
Provider Name (Legal Business Name): KYRA BOLER APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 N PORTER AVE STE 208A
NORMAN OK
73071-6485
US

IV. Provider business mailing address

900 N PORTER AVE STE 208A
NORMAN OK
73071-6485
US

V. Phone/Fax

Practice location:
  • Phone: 405-579-1444
  • Fax: 405-513-0337
Mailing address:
  • Phone: 405-579-1444
  • Fax: 405-513-0337

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LN0005X
TaxonomyCritical Care Neonatal Nurse Practitioner
License Number106258
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: