Provider Demographics
NPI:1700544038
Name:KERSEY, TIARA GAYLYNN (APRN)
Entity Type:Individual
Prefix:
First Name:TIARA
Middle Name:GAYLYNN
Last Name:KERSEY
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:TIARA
Other - Middle Name:G
Other - Last Name:STEWART
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:535 NW 9TH ST STE 220
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73102-1072
Mailing Address - Country:US
Mailing Address - Phone:405-272-8498
Mailing Address - Fax:405-272-8425
Practice Address - Street 1:535 NW 9TH ST STE 220
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73102-1072
Practice Address - Country:US
Practice Address - Phone:405-272-8498
Practice Address - Fax:405-272-8425
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-03
Last Update Date:2021-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK75300363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty