Healthcare Provider Details

I. General information

NPI: 1457555419
Provider Name (Legal Business Name): SUSAN J KINCAID ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/13/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11200 N PORTLAND AVE
OKLAHOMA CITY OK
73120-5045
US

IV. Provider business mailing address

11200 N PORTLAND AVE
OKLAHOMA CITY OK
73120-5045
US

V. Phone/Fax

Practice location:
  • Phone: 405-936-1100
  • Fax: 405-936-1122
Mailing address:
  • Phone: 405-936-1100
  • Fax: 405-936-1122

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License NumberR0019478
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: