Provider Demographics
NPI:1780030981
Name:ZELLNER, KEVIN (APRN)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:
Last Name:ZELLNER
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:733 TURTLE CREEK RD
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73170-1608
Mailing Address - Country:US
Mailing Address - Phone:405-924-6992
Mailing Address - Fax:
Practice Address - Street 1:707 NE 21ST ST
Practice Address - Street 2:
Practice Address - City:NEWCASTLE
Practice Address - State:OK
Practice Address - Zip Code:73065-6179
Practice Address - Country:US
Practice Address - Phone:405-924-6992
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-06
Last Update Date:2021-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK103197363LF0000X
TX1055990363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily