Individual
MRS. KATIE BOONE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CNP
Contact information
Practice address
3306 N KICKAPOO AVE STE 150, SHAWNEE, OK 74804-1718
(405) 628-6535
(405) 972-7587
Mailing address
7800 NW 85TH TER, OKLAHOMA CITY, OK 73132-3385
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
92966
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200604490A
—
OK
01
—
442155YMU8
MEDICARE PTAN
OK
Enumeration date
06/12/2015
Last updated
10/26/2022
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