Provider Demographics
NPI:1811382187
Name:HAAG, KATHRYN (MSFNP-C)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:
Last Name:HAAG
Suffix:
Gender:F
Credentials:MSFNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1919 E MEMORIAL RD
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73131-1253
Mailing Address - Country:US
Mailing Address - Phone:405-341-7009
Mailing Address - Fax:405-330-1811
Practice Address - Street 1:1919 E MEMORIAL RD
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73131-1253
Practice Address - Country:US
Practice Address - Phone:405-341-7009
Practice Address - Fax:405-330-1811
Is Sole Proprietor?:No
Enumeration Date:2015-04-02
Last Update Date:2016-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK71536363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily