Healthcare Provider Details

I. General information

NPI: 1639390768
Provider Name (Legal Business Name): KAMI OPAL MOORE CNS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2007
Last Update Date: 12/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1265 S UTICA AVE SUITE 300
TULSA OK
74104-4243
US

IV. Provider business mailing address

1265 S UTICA AVE SUITE 300
TULSA OK
74104-4243
US

V. Phone/Fax

Practice location:
  • Phone: 918-592-0999
  • Fax: 918-392-0341
Mailing address:
  • Phone: 918-592-0999
  • Fax: 918-392-0341

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SA2200X
TaxonomyAdult Health Clinical Nurse Specialist
License NumberR0075063
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: