Provider Demographics
NPI:1316353568
Name:KIENKA, NANCY (NP)
Entity type:Individual
Prefix:MISS
First Name:NANCY
Middle Name:
Last Name:KIENKA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8900 SE 15TH ST
Mailing Address - Street 2:
Mailing Address - City:MIDWEST CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73110-8002
Mailing Address - Country:US
Mailing Address - Phone:405-737-3278
Mailing Address - Fax:405-737-0240
Practice Address - Street 1:2801 S DOUGLAS BLVD
Practice Address - Street 2:
Practice Address - City:MIDWEST CITY
Practice Address - State:OK
Practice Address - Zip Code:73130-7194
Practice Address - Country:US
Practice Address - Phone:405-737-3278
Practice Address - Fax:405-737-0240
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-09
Last Update Date:2020-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK84132363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily