Individual
KERRI LYNN VANDIVER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ARNP
Contact information
Practice address
11515 E 31ST ST, TULSA, OK 74146-1908
(918) 392-3944
(918) 392-3949
Mailing address
11515 E 31ST ST, TULSA, OK 74146-1908
(918) 392-3944
(918) 392-3949
Taxonomy
Speciality
Code
Description
License number
State
363LW0102X
Women's Health Nurse Practitioner
Primary
R0072206
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200044350A
—
OK
Enumeration date
11/09/2005
Last updated
05/06/2014
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