Provider Demographics
NPI:1740721117
Name:CASE, KAMILLE RENEE (APRN CNP)
Entity type:Individual
Prefix:
First Name:KAMILLE
Middle Name:RENEE
Last Name:CASE
Suffix:
Gender:F
Credentials:APRN CNP
Other - Prefix:
Other - First Name:KAMILLE
Other - Middle Name:RENEE
Other - Last Name:CASE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:APRN CNP
Mailing Address - Street 1:6532 E 71ST ST STE 150
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74133-2771
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6532 E 71ST ST STE 150
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133-2771
Practice Address - Country:US
Practice Address - Phone:918-740-4630
Practice Address - Fax:918-289-0091
Is Sole Proprietor?:No
Enumeration Date:2017-03-17
Last Update Date:2017-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR 0069752163W00000X
OK69752363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse