Individual
KERRIANNE WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
1323 E 71ST ST, TULSA, OK 74136-5045
(918) 935-2529
Mailing address
408 E VICKSBURG ST, BROKEN ARROW, OK 74011-3801
(918) 904-4016
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
206070
OK
Other
Enumeration date
05/14/2025
Last updated
05/14/2025
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