Individual
KATHLEEN BETH CONNELLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
921 NE 13TH ST, OKLAHOMA CITY, OK 73104-5007
(405) 456-3859
Mailing address
1505 MEAD LN, OKLAHOMA CITY, OK 73170-1466
(405) 410-4147
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
R0040928
OK
246X00000X
Cardiovascular Specialist/Technologist
Primary
102399
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
102399
ARDMS
—
01
—
R0040928
OK BOARD OF NURSING
OK
Enumeration date
10/31/2019
Last updated
10/31/2019
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