Provider Demographics
NPI:1922465558
Name:JOSEPH, ELIZABETH NIMMY (FNP-C)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:NIMMY
Last Name:JOSEPH
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:NIMMY
Other - Last Name:KURIAKOSE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8421 NW 74TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73132-3704
Mailing Address - Country:US
Mailing Address - Phone:405-371-1975
Mailing Address - Fax:
Practice Address - Street 1:8421 NW 74TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73132-3704
Practice Address - Country:US
Practice Address - Phone:405-371-1975
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-27
Last Update Date:2016-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0080184363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily