Individual
KELLY KUSHNERICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
5801 E 41ST ST STE 900, TULSA, OK 74135-5631
(918) 934-8347
(918) 743-8552
Mailing address
5801 E 41ST ST STE 900, TULSA, OK 74135-5631
(918) 934-8347
(918) 743-8552
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
2536
OK
363AS0400X
Surgical Physician Assistant
2536
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200601130A
—
OK
Enumeration date
03/11/2015
Last updated
05/07/2025
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