Individual ProviderKatheryn Noel VandiverNurse 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 does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records yesterday at 9:44 AM.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