Healthcare Provider Details

I. General information

NPI: 1023020641
Provider Name (Legal Business Name): KYLE W RICKNER M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2006
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3808 S. BLVD
EDMOND OK
73013
US

IV. Provider business mailing address

3808 S. BLVD
EDMOND OK
73013
US

V. Phone/Fax

Practice location:
  • Phone: 405-471-5655
  • Fax:
Mailing address:
  • Phone: 405-471-5655
  • Fax: 405-494-7274

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number21266
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: