Provider Demographics
NPI:1154764801
Name:KENRICK, AMBER ESTELLE (LPN)
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:ESTELLE
Last Name:KENRICK
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 NW 17TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73103-3412
Mailing Address - Country:US
Mailing Address - Phone:405-593-7793
Mailing Address - Fax:405-239-2637
Practice Address - Street 1:1214 N HUDSON AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73103-3717
Practice Address - Country:US
Practice Address - Phone:405-239-6815
Practice Address - Fax:405-239-2637
Is Sole Proprietor?:No
Enumeration Date:2013-04-12
Last Update Date:2013-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK0057935164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse