Individual
VANESSA L KENNISON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ARNP
Contact information
Practice address
1120 S UTICA AVE, SUITE 3074, TULSA, OK 74104-4012
(918) 579-7100
(918) 579-7110
Mailing address
1120 S UTICA AVE, SUITE 3074, TULSA, OK 74104-4012
(918) 579-7100
(918) 579-7110
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
R0062587
OK
363L00000X
Nurse Practitioner
Primary
R0062587
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200120870A
—
OK
Enumeration date
06/21/2006
Last updated
02/10/2016
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