Healthcare Provider Details

I. General information

NPI: 1487948915
Provider Name (Legal Business Name): KATIE NICOLE BURDEN-GREER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2011
Last Update Date: 07/23/2024
Certification Date: 07/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 W MAIN ST
WELEETKA OK
74880
US

IV. Provider business mailing address

1921 STONECIPHER BLVD
ADA OK
74820
US

V. Phone/Fax

Practice location:
  • Phone: 918-650-6010
  • Fax: 918-332-9158
Mailing address:
  • Phone: 580-436-3980
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number30857
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: