Provider Demographics
NPI:1952379208
Name:KEARNS, LAURI J (MD)
Entity type:Individual
Prefix:
First Name:LAURI
Middle Name:J
Last Name:KEARNS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:715 S LAHOMA AVE
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73069-4507
Mailing Address - Country:US
Mailing Address - Phone:405-292-6251
Mailing Address - Fax:
Practice Address - Street 1:320 12TH AVE NE
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73071-5238
Practice Address - Country:US
Practice Address - Phone:405-573-3821
Practice Address - Fax:405-573-8256
Is Sole Proprietor?:No
Enumeration Date:2006-03-12
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK178832084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Not Answered2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK1117883Medicaid
C62855Medicare UPIN
OK24R601809Medicare ID - Type Unspecified