1477903680 NPI number — MRS. KATHLEEN DANIELLE CUMMENS APRN, FNP-C

Table of content: MRS. KATHLEEN DANIELLE CUMMENS APRN, FNP-C (NPI 1477903680)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477903680 NPI number — MRS. KATHLEEN DANIELLE CUMMENS APRN, FNP-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CUMMENS
Provider First Name:
KATHLEEN
Provider Middle Name:
DANIELLE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
APRN, FNP-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DALKE
Provider Other First Name:
KATHLEEN
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
RN
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1477903680
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/09/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 751
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HULBERT
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
74441-0751
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
918-772-3390
Provider Business Mailing Address Fax Number:
918-772-2244

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1500 E DOWNING ST STE 214
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TAHLEQUAH
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
74464-3379
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
918-432-1020
Provider Business Practice Location Address Fax Number:
918-431-0203
Provider Enumeration Date:
06/18/2016

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 163WC0200X , with the licence number:  2016019945 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 163WC0200X , with the licence number: 096071 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363LF0000X , with the licence number: 2016034309 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)