Healthcare Provider Details

I. General information

NPI: 1700488079
Provider Name (Legal Business Name): KANOELANI PATTERSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/12/2020
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 N 10TH ST
DUNCAN OK
73533-4611
US

IV. Provider business mailing address

2524 N BROADWAY STE 583
EDMOND OK
73034-4172
US

V. Phone/Fax

Practice location:
  • Phone: 580-574-0886
  • Fax:
Mailing address:
  • Phone: 580-248-5780
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number20698
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: