Healthcare Provider Details

I. General information

NPI: 1629454673
Provider Name (Legal Business Name): PANG LEILANI KUE FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: PANG TSENG KUE

II. Dates (important events)

Enumeration Date: 07/31/2015
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1323 E 71ST ST
TULSA OK
74136-5045
US

IV. Provider business mailing address

1323 E 71ST ST
TULSA OK
74136-5045
US

V. Phone/Fax

Practice location:
  • Phone: 918-492-2554
  • Fax:
Mailing address:
  • Phone: 918-492-2554
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberR0135910
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: