Provider Demographics
NPI:1033530266
Name:ROHWER, KELLIE LEANNE (APRN-CNP)
Entity Type:Individual
Prefix:
First Name:KELLIE
Middle Name:LEANNE
Last Name:ROHWER
Suffix:
Gender:F
Credentials:APRN-CNP
Other - Prefix:
Other - First Name:KELLIE
Other - Middle Name:LEANNE
Other - Last Name:HARLOW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN-CNP
Mailing Address - Street 1:7800 NW 85TH TER
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73132-3385
Mailing Address - Country:US
Mailing Address - Phone:405-608-3800
Mailing Address - Fax:
Practice Address - Street 1:4050 W MEMORIAL RD
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120-8382
Practice Address - Country:US
Practice Address - Phone:405-608-3800
Practice Address - Fax:405-608-4768
Is Sole Proprietor?:No
Enumeration Date:2013-12-13
Last Update Date:2020-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK75515363LA2200X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200522180AMedicaid