Healthcare Provider Details

I. General information

NPI: 1326034778
Provider Name (Legal Business Name): KANDI LYNN CUNNINGHAM ARNP-CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KANDI FAULKS CUNNINGHAM ARNP-CNP

II. Dates (important events)

Enumeration Date: 09/21/2005
Last Update Date: 10/14/2024
Certification Date: 10/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 E PECAN ST
ALTUS OK
73521-6141
US

IV. Provider business mailing address

1200 E PECAN ST
ALTUS OK
73521-6141
US

V. Phone/Fax

Practice location:
  • Phone: 580-379-6100
  • Fax: 580-379-6109
Mailing address:
  • Phone: 580-379-6100
  • Fax: 580-379-6109

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number44356
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number44356
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: