Healthcare Provider Details

I. General information

NPI: 1356979645
Provider Name (Legal Business Name): KAYLA CAMPBELL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/31/2020
Last Update Date: 03/31/2020
Certification Date: 03/31/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

STEPHENSON CANCER CENTER 800 NE 10TH STREET
OKLAHOMA CITY OK
73104
US

IV. Provider business mailing address

2200 CASTLE ROCK
EDMOND OK
73003-4775
US

V. Phone/Fax

Practice location:
  • Phone: 405-271-7559
  • Fax: 405-271-1360
Mailing address:
  • Phone: 405-659-5543
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133VN1301X
TaxonomyOncology Nutrition Registered Dietitian
License Number550
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number550
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: