Provider Demographics
NPI:1740735570
Name:KAUTZ, VALERIE SUZANNE (APRN)
Entity Type:Individual
Prefix:
First Name:VALERIE
Middle Name:SUZANNE
Last Name:KAUTZ
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1505 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:STIGLER
Mailing Address - State:OK
Mailing Address - Zip Code:74462-2913
Mailing Address - Country:US
Mailing Address - Phone:918-967-3368
Mailing Address - Fax:918-967-4582
Practice Address - Street 1:212 W SPAULDING ST
Practice Address - Street 2:
Practice Address - City:CHECOTAH
Practice Address - State:OK
Practice Address - Zip Code:74426-2452
Practice Address - Country:US
Practice Address - Phone:918-473-0048
Practice Address - Fax:918-473-4547
Is Sole Proprietor?:No
Enumeration Date:2016-08-22
Last Update Date:2016-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK81153363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK$$$$$$$$$OtherSOCIAL SECURITY NUMBER