Organization
VIBRANT HEALTH APRN PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. KENNETH P WARREN APRN (OWNER)
(918) 591-3567
Entity
Organization
Contact information
Practice address
1822 E 15TH ST STE A, TULSA, OK 74104-4647
(918) 591-3567
(918) 591-3568
Mailing address
2121 S COLUMBIA AVE, STE 300, TULSA, OK 74114-3501
(918) 591-3567
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
50761
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200413230A
—
OK
Enumeration date
01/06/2012
Last updated
01/15/2019
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