Healthcare Provider Details

I. General information

NPI: 1720924178
Provider Name (Legal Business Name): KENNETH WAYNE YERTON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/27/2026
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1916 E PERKINS AVE
GUTHRIE OK
73044-5804
US

IV. Provider business mailing address

1916 E PERKINS AVE
GUTHRIE OK
73044-5804
US

V. Phone/Fax

Practice location:
  • Phone: 405-887-0288
  • Fax:
Mailing address:
  • Phone: 405-887-0288
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: