Provider Demographics
NPI:1346652930
Name:WRATTEN, KELLY (FNP-C)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:WRATTEN
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8115 S MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74133-4331
Mailing Address - Country:US
Mailing Address - Phone:918-254-6315
Mailing Address - Fax:918-403-6315
Practice Address - Street 1:9709 E 79TH ST
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133-4566
Practice Address - Country:US
Practice Address - Phone:918-994-4000
Practice Address - Fax:918-994-4090
Is Sole Proprietor?:No
Enumeration Date:2014-05-30
Last Update Date:2019-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK84787363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily