Healthcare Provider Details

I. General information

NPI: 1639990377
Provider Name (Legal Business Name): KAMI NICOLE KUYKENDALL LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/23/2024
Last Update Date: 10/23/2024
Certification Date: 10/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1733 W 33RD ST STE 120
EDMOND OK
73013-3866
US

IV. Provider business mailing address

2809 NW 14TH ST
OKLAHOMA CITY OK
73107-4749
US

V. Phone/Fax

Practice location:
  • Phone: 405-229-1909
  • Fax:
Mailing address:
  • Phone: 405-764-6108
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2733
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: