Provider Demographics
NPI:1376230128
Name:KINGORI, ANNE NYAMAGU (NP)
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:NYAMAGU
Last Name:KINGORI
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:530 N MONTE VISTA ST STE B
Mailing Address - Street 2:
Mailing Address - City:ADA
Mailing Address - State:OK
Mailing Address - Zip Code:74820-4675
Mailing Address - Country:US
Mailing Address - Phone:580-453-3230
Mailing Address - Fax:580-453-3231
Practice Address - Street 1:530 N MONTE VISTA ST
Practice Address - Street 2:
Practice Address - City:ADA
Practice Address - State:OK
Practice Address - Zip Code:74820-4675
Practice Address - Country:US
Practice Address - Phone:580-453-3230
Practice Address - Fax:580-453-3231
Is Sole Proprietor?:No
Enumeration Date:2023-04-21
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1113212363LP0808X
OK212569363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health