# MR. KENNETH P WARREN

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1013909324
- **Gender:** Man
- **Credential:** APRN

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363L00000X | Nurse Practitioner | R0050761 | OK | Yes |

## Other

- **Enumeration date:** 08/22/2005
- **Last updated:** 06/11/2021

## 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 |