Healthcare Provider Details

I. General information

NPI: 1336762186
Provider Name (Legal Business Name): KONNER CUE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2020
Last Update Date: 04/01/2021
Certification Date: 04/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2905 N HARVARD AVE
OKLAHOMA CITY OK
73127-1945
US

IV. Provider business mailing address

22999 HIGHWAY 59 N
KINGWOOD TX
77339-4412
US

V. Phone/Fax

Practice location:
  • Phone: 785-562-7256
  • Fax:
Mailing address:
  • Phone: 281-348-3320
  • Fax: 281-295-5214

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: