Provider Demographics
NPI:1831845601
Name:NELSON, KI'ARA KAPRIXIA
Entity type:Individual
Prefix:
First Name:KI'ARA
Middle Name:KAPRIXIA
Last Name:NELSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4326 S 109TH EAST AVE APT 1104
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74146-5312
Mailing Address - Country:US
Mailing Address - Phone:408-705-7319
Mailing Address - Fax:
Practice Address - Street 1:4326 S 109TH EAST AVE APT 1104
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74146-5312
Practice Address - Country:US
Practice Address - Phone:408-705-7319
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-01
Last Update Date:2022-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2401224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant