MEDICARE: DR. CHERYL ANN KILPATRICK PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	279	OK

General Provider Information

NPI Number	:	1356459523
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHERYL ANN KILPATRICK PHD

Provider Business Mailing Address
First Line	:	3223 EAST 31ST STREET
Second Line	:	STE 201
City	:	TULSA
State	:	OK
Zip	:	74105-2444
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4870 S LEWIS AVE
Second Line	:	STE 230
City	:	TULSA
State	:	OK
Zip	:	74105-5151
Country	:	US
Telephone Number	:	918-749-6935
Fax Number	:	918-749-7611

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/28/2006
Last Update Date	:	06/01/2016

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