Provider Demographics
NPI:1043995293
Name:MUNIZ, KALEI KANANI-BLUE (APRN-CNP)
Entity type:Individual
Prefix:MRS
First Name:KALEI
Middle Name:KANANI-BLUE
Last Name:MUNIZ
Suffix:
Gender:F
Credentials:APRN-CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 PARK PL
Mailing Address - Street 2:
Mailing Address - City:MUSTANG
Mailing Address - State:OK
Mailing Address - Zip Code:73064-3104
Mailing Address - Country:US
Mailing Address - Phone:405-376-5439
Mailing Address - Fax:
Practice Address - Street 1:500 PARK PL
Practice Address - Street 2:
Practice Address - City:MUSTANG
Practice Address - State:OK
Practice Address - Zip Code:73064-3104
Practice Address - Country:US
Practice Address - Phone:405-376-5439
Practice Address - Fax:405-376-6459
Is Sole Proprietor?:No
Enumeration Date:2023-06-15
Last Update Date:2023-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK213355363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily