Provider Demographics
NPI:1730724063
Name:KLOSKE, JOAN ELIZABETH
Entity type:Individual
Prefix:
First Name:JOAN
Middle Name:ELIZABETH
Last Name:KLOSKE
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:JOAN
Other - Middle Name:
Other - Last Name:KLOSKE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:FNP-CNP
Mailing Address - Street 1:6728 S HUDSON AVE
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73139-7407
Mailing Address - Country:US
Mailing Address - Phone:405-271-5860
Mailing Address - Fax:
Practice Address - Street 1:700 NE 13TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73104-5004
Practice Address - Country:US
Practice Address - Phone:405-271-3667
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-11
Last Update Date:2020-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK86533363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care