Basic Information
| Provider Information | |||||||||
| NPI: | 1275828030 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PIBURN | ||||||||
| FirstName: | KATHRYN | ||||||||
| MiddleName: | AUDELL | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | ARNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2801 E MEMORIAL RD | ||||||||
| Address2: | SUITE 140 | ||||||||
| City: | EDMOND | ||||||||
| State: | OK | ||||||||
| PostalCode: | 730136474 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4054256100 | ||||||||
| FaxNumber: | 4053301811 | ||||||||
| Practice Location | |||||||||
| Address1: | 1887 SPILLWAY RD STE 140 | ||||||||
| Address2: | |||||||||
| City: | BRANDON | ||||||||
| State: | MS | ||||||||
| PostalCode: | 39047 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6019925532 | ||||||||
| FaxNumber: | 6019925547 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/09/2011 | ||||||||
| LastUpdateDate: | 06/06/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 118108 | OK | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 363LF0000X | 902549 | MS | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.