Provider Demographics
NPI:1639994668
Name:BARRETT, KENNEDY (APRN)
Entity type:Individual
Prefix:
First Name:KENNEDY
Middle Name:
Last Name:BARRETT
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:777 NW 63RD ST FL 4TH
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73116-7601
Mailing Address - Country:US
Mailing Address - Phone:405-272-6193
Mailing Address - Fax:405-272-7455
Practice Address - Street 1:4651 N HARRISON ST
Practice Address - Street 2:
Practice Address - City:SHAWNEE
Practice Address - State:OK
Practice Address - Zip Code:74804-1440
Practice Address - Country:US
Practice Address - Phone:405-395-5655
Practice Address - Fax:405-395-5654
Is Sole Proprietor?:No
Enumeration Date:2024-11-15
Last Update Date:2025-01-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK220145363L00000X, 363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner