Provider Demographics
NPI:1578523148
Name:OWENS, KERRY C (MD)
Entity Type:Individual
Prefix:DR
First Name:KERRY
Middle Name:C
Last Name:OWENS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3400 NW EXPRESSWAY
Mailing Address - Street 2:800
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-4493
Mailing Address - Country:US
Mailing Address - Phone:405-552-2961
Mailing Address - Fax:405-945-5810
Practice Address - Street 1:3400 NW EXPRESSWAY
Practice Address - Street 2:800
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-4493
Practice Address - Country:US
Practice Address - Phone:405-552-2961
Practice Address - Fax:405-945-5810
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK20074174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKH13832Medicare UPIN