Provider Demographics
NPI:1477903680
Name:CUMMENS, KATHLEEN DANIELLE (APRN, FNP-C)
Entity type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:DANIELLE
Last Name:CUMMENS
Suffix:
Gender:F
Credentials:APRN, FNP-C
Other - Prefix:
Other - First Name:KATHLEEN
Other - Middle Name:
Other - Last Name:DALKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:PO BOX 751
Mailing Address - Street 2:
Mailing Address - City:HULBERT
Mailing Address - State:OK
Mailing Address - Zip Code:74441-0751
Mailing Address - Country:US
Mailing Address - Phone:918-772-3390
Mailing Address - Fax:918-772-2244
Practice Address - Street 1:1500 E DOWNING ST STE 214
Practice Address - Street 2:
Practice Address - City:TAHLEQUAH
Practice Address - State:OK
Practice Address - Zip Code:74464-3379
Practice Address - Country:US
Practice Address - Phone:918-432-1020
Practice Address - Fax:918-431-0203
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-18
Last Update Date:2020-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2016019945163WC0200X
MO2016034309363LF0000X
OK096071163WC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily