Healthcare Provider Details

I. General information

NPI: 1841783743
Provider Name (Legal Business Name): KENDRA ELIZABETH THOMPSON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KENDRA ELIZABETH EDWARDS

II. Dates (important events)

Enumeration Date: 06/14/2018
Last Update Date: 06/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 NW EXPRESSWAY
OKLAHOMA CITY OK
73112-4999
US

IV. Provider business mailing address

8113 HILLERS RD
OKLAHOMA CITY OK
73132-4640
US

V. Phone/Fax

Practice location:
  • Phone: 405-949-3505
  • Fax:
Mailing address:
  • Phone: 405-570-3528
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number101487
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License Number101487
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: