Individual
KJETIL LAURITSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
6161 S YALE AVE, TULSA, OK 74136-1902
(918) 494-2200
Mailing address
6161 S YALE AVE, TULSA, OK 74136-1902
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
2761
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2761
STATE OF OKLAHOMA BOARD OF MEDICAL LICENSURE AND SUPERVISION
OK
Enumeration date
04/05/2017
Last updated
04/05/2017
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