Individual
KOURTNEY PETERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
721 W BRITTON RD, OKLAHOMA CITY, OK 73114-2909
(405) 632-6688
Mailing address
3000 N GRAND BLVD, OKLAHOMA CITY, OK 73107-1818
(405) 632-6688
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
104671
OK
363LF0000X
Family Nurse Practitioner
Primary
104671
OK
Other
Enumeration date
06/19/2016
Last updated
02/21/2024
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