Individual
KATHY DIANE SHORT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
229 E MEADE DR, YUKON, OK 73099-5749
(405) 402-8848
(405) 265-7852
Mailing address
229 E MEADE DR, YUKON, OK 73099-5749
(405) 402-8848
(405) 265-7852
Taxonomy
Speciality
Code
Description
License number
State
163WG0000X
General Practice Registered Nurse
Primary
25882
OK
Other
Enumeration date
05/04/2018
Last updated
05/04/2018
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