Provider Demographics
NPI:1598316960
Name:NIPPER, KATHRYN L (BSN RN)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:L
Last Name:NIPPER
Suffix:
Gender:F
Credentials:BSN RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1716 AURORA PL
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-2960
Mailing Address - Country:US
Mailing Address - Phone:580-763-7337
Mailing Address - Fax:
Practice Address - Street 1:JANE MORRIS
Practice Address - Street 2:13 HILLCREST DR
Practice Address - City:PONCA CITY
Practice Address - State:OK
Practice Address - Zip Code:74604
Practice Address - Country:US
Practice Address - Phone:580-716-1729
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-26
Last Update Date:2019-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK134079163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty