Healthcare Provider Details

I. General information

NPI: 1558105973
Provider Name (Legal Business Name): KYLIE HANDA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/20/2024
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 CHILDRENS AVE
OKLAHOMA CITY OK
73104-4637
US

IV. Provider business mailing address

844 NW 43RD ST APT 202
OKLAHOMA CITY OK
73118-6812
US

V. Phone/Fax

Practice location:
  • Phone: 405-271-4417
  • Fax:
Mailing address:
  • Phone: 321-626-1441
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number1184R
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: