Healthcare Provider Details

I. General information

NPI: 1982428967
Provider Name (Legal Business Name): KYLA SPANN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2024
Last Update Date: 11/14/2024
Certification Date: 11/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 W BROADWAY ST
ANADARKO OK
73005-2421
US

IV. Provider business mailing address

314 W KENTUCKY AVE
ANADARKO OK
73005-4019
US

V. Phone/Fax

Practice location:
  • Phone: 405-247-2425
  • Fax:
Mailing address:
  • Phone: 405-933-1787
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: