Provider Demographics
NPI:1982298196
Name:MURRAY, KASONDRA
Entity Type:Individual
Prefix:
First Name:KASONDRA
Middle Name:
Last Name:MURRAY
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 1:10750 HUNTERS POINTE
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73034-1604
Mailing Address - Country:US
Mailing Address - Phone:405-823-7678
Mailing Address - Fax:
Practice Address - Street 1:13310 N EASTERN AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73131-1816
Practice Address - Country:US
Practice Address - Phone:405-513-7333
Practice Address - Fax:405-813-7337
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-28
Last Update Date:2023-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKF02210851363LF0000X
OK201495363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily