Provider Demographics
NPI:1962744359
Name:KLIMENKO, TETYANA VOLODYMYRIVNA (APRN)
Entity type:Individual
Prefix:
First Name:TETYANA
Middle Name:VOLODYMYRIVNA
Last Name:KLIMENKO
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:8803 S 101ST EAST AVE
Mailing Address - Street 2:STE 255
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74133-5760
Mailing Address - Country:US
Mailing Address - Phone:918-294-6840
Mailing Address - Fax:918-298-6839
Practice Address - Street 1:8803 SOUTH 101ST EAST AVENUE
Practice Address - Street 2:SUITE 255
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133-5760
Practice Address - Country:US
Practice Address - Phone:918-294-6840
Practice Address - Fax:918-298-6839
Is Sole Proprietor?:No
Enumeration Date:2013-03-23
Last Update Date:2014-05-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OK86371363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200481450AMedicaid
OK283807YMU8Medicare UPIN
OK200481450AMedicaid