Individual ProviderKatheryn Noel Vandiver, APRNNurse PractitionerPhysician Assistants & Advanced Practice Nursing ProvidersPractice Address2100 SW 119th St, Oklahoma City, OK 73170-3437(405) 691-1041PECOS EnrollmentBased on the most recent information from CMS, provider Katheryn Noel Vandiver is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.Part BMedicare Part BEnrolledHHAHome Health AgencyEnrolledDMEDurable Medical EquipmentEnrolledPMDPower Mobility DeviceEnrolledCMS last updated its PECOS records 2 days ago.Profile DetailsProvider ID1235481771Provider TypeIndividualFull NameVandiver, Katheryn NoelCredentialAPRNGenderFemaleSole ProprietorYesEnumeration Date10/8/2012Last Updated6/30/2021Contact InformationPractice LocationPractice Address2100 SW 119th St, Oklahoma City, OK 73170-3437Phone(405) 691-1041Fax(405) 378-3480Mailing LocationMailing Address2100 SW 119th St, Oklahoma City, OK 73170-3437Phone(405) 691-1041Fax(405) 378-3480Provider TaxonomiesCodeDescriptionLicenseCode363LF0000XPrimaryDescriptionNurse PractitionerPhysician Assistants & Advanced Practice Nursing ProvidersLicense88767Oklahoma