Healthcare Provider Details

I. General information

NPI: 1972989283
Provider Name (Legal Business Name): KAYLA LUCKETT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2015
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 W EDMOND RD
EDMOND OK
73003-5600
US

IV. Provider business mailing address

472 AUBURN LN
PIEDMONT OK
73078-7828
US

V. Phone/Fax

Practice location:
  • Phone: 405-216-3391
  • Fax:
Mailing address:
  • Phone: 405-742-2929
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: