Individual
KELSEY DONNETTE KRUCKEBERG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN-CNP
Contact information
Practice address
8115 S MEMORIAL DR, TULSA, OK 74133-4331
(918) 254-6315
Mailing address
11528 S MULBERRY LN, JENKS, OK 74037-2123
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
R0114800
OK
Other
Enumeration date
07/23/2019
Last updated
07/23/2019
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