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Individual
MR. KENNETH P WARREN
Active
Individual
MR. KENNETH P WARREN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
APRN
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
R0050761
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100198180A
—
OK
01
—
1013909324
PROVIDER INDIVIDUAL NPI
OK
01
—
1811267891
GROUP NPI
OK
01
—
76063966-006
BCBSOK
OK
01
—
OKAAA3489
MEDICARE PTAN INDIVIDUAL
OK
05
—
OKAAA3489
—
OK
01
—
OKAAA3490
GROUP PTAN
OK
Enumeration date
08/22/2005
Last updated
06/11/2021
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