Provider Demographics
NPI:1083250757
Name:STEVENS, KYNDAL RENEE' (APRN-CNP)
Entity Type:Individual
Prefix:MS
First Name:KYNDAL
Middle Name:RENEE'
Last Name:STEVENS
Suffix:
Gender:F
Credentials:APRN-CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1409 W 118TH ST S
Mailing Address - Street 2:
Mailing Address - City:JENKS
Mailing Address - State:OK
Mailing Address - Zip Code:74037-4262
Mailing Address - Country:US
Mailing Address - Phone:405-642-2308
Mailing Address - Fax:
Practice Address - Street 1:2617 S ELM PL
Practice Address - Street 2:
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74012-7850
Practice Address - Country:US
Practice Address - Phone:918-455-0414
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-18
Last Update Date:2019-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK97099363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily