Provider Demographics
NPI:1851447726
Name:GRIFFIN, KATHY SUE (LPN)
Entity Type:Individual
Prefix:MRS
First Name:KATHY
Middle Name:SUE
Last Name:GRIFFIN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1206 S MONROE ST
Mailing Address - Street 2:
Mailing Address - City:ENID
Mailing Address - State:OK
Mailing Address - Zip Code:73701-7310
Mailing Address - Country:US
Mailing Address - Phone:580-242-3437
Mailing Address - Fax:
Practice Address - Street 1:13 HILLCREST DR
Practice Address - Street 2:
Practice Address - City:PONCA CITY
Practice Address - State:OK
Practice Address - Zip Code:74604-4808
Practice Address - Country:US
Practice Address - Phone:580-765-1777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKL0026399164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse