MEDICARE: KAYLIE REIGH CERFUS

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	171M00000X	Case Manager/Care Coordinator		OK

General Provider Information

NPI Number	:	1720946791
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAYLIE REIGH CERFUS

Provider Business Mailing Address
First Line	:	15050 W 18TH PL S
Second Line	:
City	:	SAND SPRINGS
State	:	OK
Zip	:	74063-4269
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	15050 W 18TH PL S
Second Line	:
City	:	SAND SPRINGS
State	:	OK
Zip	:	74063-4269
Country	:	US
Telephone Number	:	803-580-9238
Fax Number	:

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

Provider Enumeration Date	:	01/09/2026
Last Update Date	:	01/09/2026

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