Healthcare Provider Details

I. General information

NPI: 1386444149
Provider Name (Legal Business Name): KAYLEN NGUYEN
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2025
Last Update Date: 03/19/2025
Certification Date: 03/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 N EASTERN AVE
MOORE OK
73160-5833
US

IV. Provider business mailing address

400 N EASTERN AVE
MOORE OK
73160-5833
US

V. Phone/Fax

Practice location:
  • Phone: 405-757-7818
  • Fax: 405-706-0645
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number222495
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: