Provider Demographics
NPI:1912313453
Name:DICKSON REESE, KENDRA ANN (LPN)
Entity type:Individual
Prefix:MRS
First Name:KENDRA
Middle Name:ANN
Last Name:DICKSON REESE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MRS
Other - First Name:KENDRA
Other - Middle Name:ANN
Other - Last Name:PARRISH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:223 N SIOUX
Mailing Address - Street 2:
Mailing Address - City:SAND SPRINGS
Mailing Address - State:OK
Mailing Address - Zip Code:74063-7539
Mailing Address - Country:US
Mailing Address - Phone:918-630-5453
Mailing Address - Fax:
Practice Address - Street 1:650 S PEORIA AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74120-4429
Practice Address - Country:US
Practice Address - Phone:918-587-9471
Practice Address - Fax:918-560-1399
Is Sole Proprietor?:No
Enumeration Date:2014-07-04
Last Update Date:2014-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKL 0057263164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse