Healthcare Provider Details

I. General information

NPI: 1629189931
Provider Name (Legal Business Name): R. GREG KUYKENDALL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 03/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3201 N VAN BUREN ST STE 200
ENID OK
73703-1800
US

IV. Provider business mailing address

3201 N VAN BUREN ST STE 200
ENID OK
73703-1800
US

V. Phone/Fax

Practice location:
  • Phone: 580-234-6168
  • Fax: 580-233-4130
Mailing address:
  • Phone: 580-234-6168
  • Fax: 580-233-4130

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number451
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: