Provider Demographics
NPI:1396769493
Name:KLINE, TERESA (NP)
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:
Last Name:KLINE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8115 S MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74133-4331
Mailing Address - Country:US
Mailing Address - Phone:918-254-6315
Mailing Address - Fax:918-403-6315
Practice Address - Street 1:8115 S MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133-4331
Practice Address - Country:US
Practice Address - Phone:918-254-6315
Practice Address - Fax:918-293-3161
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2016-11-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OKR0021183363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKP11946Medicare UPIN