Healthcare Provider Details

I. General information

NPI: 1730724063
Provider Name (Legal Business Name): JOAN ELIZABETH KLOSKE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JOAN KLOSKE FNP-CNP

II. Dates (important events)

Enumeration Date: 11/11/2019
Last Update Date: 03/11/2020
Certification Date: 03/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 NE 13TH ST
OKLAHOMA CITY OK
73104-5004
US

IV. Provider business mailing address

6728 S HUDSON AVE
OKLAHOMA CITY OK
73139-7407
US

V. Phone/Fax

Practice location:
  • Phone: 405-271-3667
  • Fax:
Mailing address:
  • Phone: 405-271-5860
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number86533
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: