Provider Demographics
NPI:1487837910
Name:VINSON, PAULA KRISTINE (BSN,RNC-OB,IBCLC,RLC)
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:KRISTINE
Last Name:VINSON
Suffix:
Gender:F
Credentials:BSN,RNC-OB,IBCLC,RLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11541 HAMPTON DR
Mailing Address - Street 2:
Mailing Address - City:MIDWEST CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73130-8218
Mailing Address - Country:US
Mailing Address - Phone:405-761-1644
Mailing Address - Fax:
Practice Address - Street 1:4801 INTEGRIS PKWY
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73034-8864
Practice Address - Country:US
Practice Address - Phone:405-657-3250
Practice Address - Fax:405-471-0017
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-06
Last Update Date:2023-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174400000X
OK90483163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200212650AMedicaid