Individual
MR. KENNETH P WARREN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
APRN
Contact information
Practice address
2202 E 49TH ST STE 600, TULSA, OK 74105-8716
(918) 591-3567
(918) 591-3568
Mailing address
2202 E 49TH ST STE 600, TULSA, OK 74105-8716
(918) 591-3567
(918) 591-3568
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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