Healthcare Provider Details

I. General information

NPI: 1174457790
Provider Name (Legal Business Name): KAVI YULANDO CLINE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

4400 N LINCOLN BLVD
OKLAHOMA CITY OK
73105-5108
US

IV. Provider business mailing address

908 CLAREMONT ST
WEATHERFORD OK
73096-3406
US

V. Phone/Fax

Practice location:
  • Phone: 405-424-7711
  • Fax: 405-425-0343
Mailing address:
  • Phone: 580-791-2671
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: