Provider Demographics
NPI:1033218896
Name:GREGORY, KAREN LAVON (CNS)
Entity Type:Individual
Prefix:MS
First Name:KAREN
Middle Name:LAVON
Last Name:GREGORY
Suffix:
Gender:F
Credentials:CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:750 NE 13TH STREET
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73104-5051
Mailing Address - Country:US
Mailing Address - Phone:405-235-0040
Mailing Address - Fax:405-235-4495
Practice Address - Street 1:750 NE 13TH STREET
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73104-5051
Practice Address - Country:US
Practice Address - Phone:405-235-0040
Practice Address - Fax:405-235-4495
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2011-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR71506174400000X
OKR0071506363L00000X
TX725403364SA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SA2100XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAcute Care
No174400000XOther Service ProvidersSpecialist
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200113920AMedicaid