Healthcare Provider Details

I. General information

NPI: 1588290522
Provider Name (Legal Business Name): KYLA S HOBSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/22/2020
Last Update Date: 03/22/2020
Certification Date: 03/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

915 E OWEN K GARRIOTT RD STE M
ENID OK
73701-6155
US

IV. Provider business mailing address

4114 SHENANDOAH
ENID OK
73703-2019
US

V. Phone/Fax

Practice location:
  • Phone: 580-233-4244
  • Fax:
Mailing address:
  • Phone: 405-853-5075
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberI-10066
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: