Healthcare Provider Details

I. General information

NPI: 1154242337
Provider Name (Legal Business Name): KAYLA P BOBO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2026
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2405 PALMER CIR STE 100
NORMAN OK
73069-6351
US

IV. Provider business mailing address

2405 PALMER CIR STE 100
NORMAN OK
73069-6351
US

V. Phone/Fax

Practice location:
  • Phone: 972-769-5938
  • Fax:
Mailing address:
  • Phone: 972-769-5938
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-26-2832143
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: