Healthcare Provider Details

I. General information

NPI: 1386307361
Provider Name (Legal Business Name): AMY KYLE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/18/2021
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9404 NE 14TH ST
MIDWEST CITY OK
73130-1104
US

IV. Provider business mailing address

9404 NE 14TH ST
MIDWEST CITY OK
73130-1104
US

V. Phone/Fax

Practice location:
  • Phone: 405-900-1187
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: