Healthcare Provider Details

I. General information

NPI: 1801522800
Provider Name (Legal Business Name): JUDITH DIANE KYLE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2022
Last Update Date: 09/30/2025
Certification Date: 09/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1006 NORTHWEST BLVD
ARDMORE OK
73401-1533
US

IV. Provider business mailing address

1006 NORTHWEST BLVD
ARDMORE OK
73401-1533
US

V. Phone/Fax

Practice location:
  • Phone: 580-220-6764
  • Fax: 580-220-6383
Mailing address:
  • Phone: 580-220-6764
  • Fax: 580-220-6383

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License NumberR0053771
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: