Provider Demographics
NPI:1275828030
Name:PIBURN, KATHRYN AUDELL (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:KATHRYN
Middle Name:AUDELL
Last Name:PIBURN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2801 E MEMORIAL RD
Mailing Address - Street 2:SUITE 140
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-6474
Mailing Address - Country:US
Mailing Address - Phone:405-425-6100
Mailing Address - Fax:405-330-1811
Practice Address - Street 1:1887 SPILLWAY RD STE 140
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:MS
Practice Address - Zip Code:39047
Practice Address - Country:US
Practice Address - Phone:601-992-5532
Practice Address - Fax:601-992-5547
Is Sole Proprietor?:No
Enumeration Date:2011-06-09
Last Update Date:2018-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK118108363LF0000X, 363LF0000X
MS902549363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily