Provider Demographics
NPI:1750821658
Name:KIRKENDOLL, MONICA ANN (ARNP)
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:ANN
Last Name:KIRKENDOLL
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:MONICA
Other - Middle Name:ANN
Other - Last Name:LEWIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:PO BOX 740020
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-0020
Mailing Address - Country:US
Mailing Address - Phone:312-733-9730
Mailing Address - Fax:773-866-8014
Practice Address - Street 1:1538 N LEWIS AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74110-2535
Practice Address - Country:US
Practice Address - Phone:918-400-7001
Practice Address - Fax:539-202-5070
Is Sole Proprietor?:No
Enumeration Date:2017-02-27
Last Update Date:2022-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0103225363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily