Provider Demographics
NPI:1700277092
Name:MAPLE, KATHERINE JILL (RN)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:JILL
Last Name:MAPLE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1575 E FARRIS CEMETERY RD
Mailing Address - Street 2:
Mailing Address - City:ATOKA
Mailing Address - State:OK
Mailing Address - Zip Code:74525-8306
Mailing Address - Country:US
Mailing Address - Phone:903-223-2223
Mailing Address - Fax:
Practice Address - Street 1:506 HWY 271 NORTH
Practice Address - Street 2:
Practice Address - City:ANTLERS
Practice Address - State:OK
Practice Address - Zip Code:74523
Practice Address - Country:US
Practice Address - Phone:580-298-3001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-09
Last Update Date:2015-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK0075218163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management