Provider Demographics
NPI:1952032864
Name:FULBRIGHT, KENDRA JEAN (APRN-CNP)
Entity type:Individual
Prefix:
First Name:KENDRA
Middle Name:JEAN
Last Name:FULBRIGHT
Suffix:
Gender:F
Credentials:APRN-CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1640 W KEETOOWAH ST
Mailing Address - Street 2:
Mailing Address - City:TAHLEQUAH
Mailing Address - State:OK
Mailing Address - Zip Code:74464-3497
Mailing Address - Country:US
Mailing Address - Phone:918-708-9009
Mailing Address - Fax:918-708-1714
Practice Address - Street 1:1640 W KEETOOWAH ST
Practice Address - Street 2:
Practice Address - City:TAHLEQUAH
Practice Address - State:OK
Practice Address - Zip Code:74464-3497
Practice Address - Country:US
Practice Address - Phone:918-708-9009
Practice Address - Fax:918-708-1714
Is Sole Proprietor?:No
Enumeration Date:2022-06-21
Last Update Date:2024-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK207349363LP0808X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily