Healthcare Provider Details

I. General information

NPI: 1770497489
Provider Name (Legal Business Name): KATLYN SALAZAR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/30/2026
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

411 W GRAND AVE
CHICKASHA OK
73018-5862
US

IV. Provider business mailing address

2496 COUNTY STREET 2760
CHICKASHA OK
73018-8056
US

V. Phone/Fax

Practice location:
  • Phone: 405-224-0053
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number727958
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: