Healthcare Provider Details

I. General information

NPI: 1396691473
Provider Name (Legal Business Name): KAMILLE CASE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/10/2026
Last Update Date: 04/24/2026
Certification Date: 04/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3008 W WINSTON ST
BROKEN ARROW OK
74011-1980
US

IV. Provider business mailing address

3008 W WINSTON ST
BROKEN ARROW OK
74011-1980
US

V. Phone/Fax

Practice location:
  • Phone: 918-645-0382
  • Fax:
Mailing address:
  • Phone: 918-645-0382
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: KAMILLE CASE
Title or Position: OWNER
Credential: PMHNP
Phone: 918-645-0382