Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 110911 | OK |
NPI | 1003439258 |
---|---|
Provider Name | Rachel Kersker |
First Address | Claremore, OK 74017-3159 |
Second Address | Claremore, OK 74017-3159 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/05/2020 |
Last Update Date | 22/05/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
110911 | OBN (01) | OK |