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General NPI Number Information
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NPI Number | 1417470006
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Entity Type | Individual
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Provider Name | KERI ENNS APRN-CNP
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Gender | Female
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Dates
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Enumeration Date | 07/25/2017
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Last Update Date | 07/25/2017
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Provider Practice Location Address
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Address Line | 2440 E 81ST ST
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City | TULSA
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State | OK
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Zip | 74137-4200
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Country | US
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Telephone | 918-477-5190
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Fax |
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Provider Business Mailing Address
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Address Line | 803 N DOUGLAS ST
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City | JENKS
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State | OK
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Zip | 74037-3814
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 88694
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License Number State | OK
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