=====================================================
General NPI Number Information
=====================================================
NPI Number | 1174156525
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CURTIS JAY PURSER APRN-CNP
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/13/2020
-----------------------------------------------------
Last Update Date | 06/23/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1622 E BROADWAY ST
-----------------------------------------------------
City | MUSKOGEE
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 74403-4601
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 918-683-2851
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6348 N MILWAUKEE AVE STE 390
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60646-3728
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 847-235-6130
-----------------------------------------------------
Fax | 847-235-6135
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | R0111354
-----------------------------------------------------
License Number State | OK
-----------------------------------------------------