Individual
KATHILEE J MATAMOROS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
6820 NW 23RD ST, BETHANY, OK 73008-5217
(405) 495-5154
Mailing address
6820 NW 23RD ST, BETHANY, OK 73008-5217
(405) 495-5154
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
TLRN039071
PA
363L00000X
Nurse Practitioner
SP012283
PA
363LF0000X
Family Nurse Practitioner
90694
OK
363LF0000X
Family Nurse Practitioner
Primary
SP012283
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200526530A
—
OK
Enumeration date
06/11/2012
Last updated
04/13/2015
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