Individual provider · NPI-1

Kevin Ray Charboneau, RN

Registered Nurse, Case Management · Muskogee, OK

NPI number1780477133
StatusActive
Last updated in NPPESMay 28, 2025

Details

NPI
1780477133
Entity type
Individual (NPI-1)
Name
Mr. Kevin Ray Charboneau
Credential
RN
Sex
Male
Sole proprietor
No
Enumeration date
May 28, 2025
Certification date
May 28, 2025
Last updated
May 28, 2025

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
163WC0400X Registered Nurse, Case ManagementR0065871OKYes

Practice location

1011 Honor Heights Dr
Muskogee, OK 74401-1318

Phone 918-577-3361

Mailing address

1011 Honor Heights Dr
Muskogee, OK 74401-1318

Phone 918-577-3361

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