Individual
KATHERYN NOEL VANDIVER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
2100 SW 119TH ST, OKLAHOMA CITY, OK 73170-3437
(405) 691-1041
(405) 378-3480
Mailing address
2100 SW 119TH ST, OKLAHOMA CITY, OK 73170-3437
(405) 691-1041
(405) 378-3480
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
88767
OK
Other
Enumeration date
10/08/2012
Last updated
06/30/2021
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