Provider Demographics
NPI:1720822968
Name:MUNSELL, CEARA KATHERINE
Entity type:Individual
Prefix:
First Name:CEARA
Middle Name:KATHERINE
Last Name:MUNSELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CEARA
Other - Middle Name:KATHERINE
Other - Last Name:BAILEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:4300 W MEMORIAL RD
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73120-8304
Mailing Address - Country:US
Mailing Address - Phone:405-830-0031
Mailing Address - Fax:
Practice Address - Street 1:8304 NW 35TH ST
Practice Address - Street 2:
Practice Address - City:BETHANY
Practice Address - State:OK
Practice Address - Zip Code:73008-3522
Practice Address - Country:US
Practice Address - Phone:405-830-0031
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-22
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK220049176B00000X
OKR0128809163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
No163W00000XNursing Service ProvidersRegistered Nurse