Healthcare Provider Details

I. General information

NPI: 1023433315
Provider Name (Legal Business Name): AUSTIN JAMES KASTL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/24/2014
Last Update Date: 02/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1366 SE WASHINGTON BLVD
BARTLESVILLE OK
74006-4519
US

IV. Provider business mailing address

1366 SE WASHINGTON BLVD
BARTLESVILLE OK
74006-4519
US

V. Phone/Fax

Practice location:
  • Phone: 918-333-3828
  • Fax: 918-333-3875
Mailing address:
  • Phone: 918-333-3828
  • Fax: 918-333-3875

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246Z00000X
TaxonomyOther Specialist/Technologist
License Number
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: