Provider Demographics
NPI:1487963203
Name:BURR, KATHLEEN M (APRN-CNM)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:M
Last Name:BURR
Suffix:
Gender:F
Credentials:APRN-CNM
Other - Prefix:
Other - First Name:KATHLEEN
Other - Middle Name:M
Other - Last Name:MCCARTHY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN-CNM
Mailing Address - Street 1:PO BOX 268838
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73126-8838
Mailing Address - Country:US
Mailing Address - Phone:918-660-3632
Mailing Address - Fax:918-660-3631
Practice Address - Street 1:4444 E 41ST ST
Practice Address - Street 2:3RD FLOOR, STE B
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-2527
Practice Address - Country:US
Practice Address - Phone:918-619-4400
Practice Address - Fax:918-619-4216
Is Sole Proprietor?:No
Enumeration Date:2010-09-28
Last Update Date:2020-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK108055363LW0102X, 367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200467280AMedicaid
OK274213YLFBMedicare PIN