Healthcare Provider Details

I. General information

NPI: 1265357412
Provider Name (Legal Business Name): KAYLA CUNNINGHAM RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2026
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

916 NOBLE ST
ALVA OK
73717-2852
US

IV. Provider business mailing address

916 NOBLE ST
ALVA OK
73717-2852
US

V. Phone/Fax

Practice location:
  • Phone: 580-327-1274
  • Fax:
Mailing address:
  • Phone: 580-327-1274
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0600X
TaxonomyGerontology Registered Nurse
License NumberR0105753
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: