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Katheryn Noel Vandiver

Nurse Practitioner

Physician Assistants & Advanced Practice Nursing Providers

2100 SW 119th St, Oklahoma City, OK 73170-3437

PECOS Enrollment

This provider is enrolled in PECOS as KATHERYN VANDIVER.

Based on the most recent information from CMS, provider Katheryn Noel Vandiver is legally eligible to order and refer claims for DME and PMD services only.

Part B
Medicare Part B
Not Enrolled
HHA
Home Health Agency
Not Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Enrolled

CMS last updated its PECOS records today at 11:05 AM.

Profile Details

Provider ID
1235481771
Provider Type
Individual
Full Name
Vandiver, Katheryn Noel
Credential
APRN

Gender
Female
Sole Proprietor
Yes
Enumeration Date
10/8/2012
Last Updated
6/30/2021

Contact Information

Practice Location

2100 SW 119th St, Oklahoma City, OK 73170-3437

(405) 691-1041

(405) 378-3480

Mailing Location

2100 SW 119th St, Oklahoma City, OK 73170-3437

(405) 691-1041

(405) 378-3480

Provider Taxonomies

Code	Description	License
Code 363LF0000X Primary	Description Nurse Practitioner Physician Assistants & Advanced Practice Nursing Providers	License 88767 Oklahoma

Katheryn Noel Vandiver

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

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