MEDICARE: KENDRA BOND APRN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	R0086955	OK
2	363LP2300X	Primary Care Nurse Practitioner	204091	OK

General Provider Information

NPI Number	:	1760076731
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENDRA BOND APRN

Provider Business Mailing Address
First Line	:	2100 SW 119TH ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73170-3437
Country	:	US
Telephone Number	:	405-691-1041
Fax Number	:

Provider Business Practice Location Address
First Line	:	2100 SW 119TH ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73170-3437
Country	:	US
Telephone Number	:	405-691-1041
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/21/2021
Last Update Date	:	06/19/2024

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