Provider Demographics
NPI:1679258891
Name:WATERS, JUSTICE KAELYN (APRN, FNP-C)
Entity Type:Individual
Prefix:
First Name:JUSTICE
Middle Name:KAELYN
Last Name:WATERS
Suffix:
Gender:F
Credentials:APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 CEDAR LAKE BLVD STE 120
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73114-7815
Mailing Address - Country:US
Mailing Address - Phone:405-445-1210
Mailing Address - Fax:
Practice Address - Street 1:701 CEDAR LAKE BLVD STE 120
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73114-7815
Practice Address - Country:US
Practice Address - Phone:405-445-1210
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-15
Last Update Date:2023-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK213376363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily