Healthcare Provider Details

I. General information

NPI: 1689016131
Provider Name (Legal Business Name): JENNIFER SHEPHERD KUWITZKY APRN-CNS, MS, CCRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2013
Last Update Date: 05/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 S UTICA AVE
TULSA OK
74104-4012
US

IV. Provider business mailing address

1120 S UTICA AVE
TULSA OK
74104-4012
US

V. Phone/Fax

Practice location:
  • Phone: 918-549-8246
  • Fax:
Mailing address:
  • Phone: 918-549-8246
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SC0200X
TaxonomyCritical Care Medicine Clinical Nurse Specialist
License NumberR0041434
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: