Healthcare Provider Details

I. General information

NPI: 1114366341
Provider Name (Legal Business Name): NEXT GENERATION PEDIATRICS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2013
Last Update Date: 02/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10400 S WESTERN AVE SUITE 7
OKLAHOMA CITY OK
73139-3016
US

IV. Provider business mailing address

PO BOX 890070
OKLAHOMA CITY OK
73189-0070
US

V. Phone/Fax

Practice location:
  • Phone: 405-378-2222
  • Fax: 405-378-2240
Mailing address:
  • Phone: 405-378-2222
  • Fax: 405-378-2240

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: KIMBERLY MICHELE KUECHENMEISTER
Title or Position: MANAGER
Credential:
Phone: 405-378-2222