Healthcare Provider Details

I. General information

NPI: 1962835082
Provider Name (Legal Business Name): KATHERINE SMALL MS, LCGC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATHERINE KAERCHER MS, LCGC

II. Dates (important events)

Enumeration Date: 08/13/2013
Last Update Date: 10/27/2022
Certification Date: 10/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4140 W MEMORIAL RD STE 321
OKLAHOMA CITY OK
73120-8300
US

IV. Provider business mailing address

2055 ARBOR VALLEY DR
EDMOND OK
73025-1849
US

V. Phone/Fax

Practice location:
  • Phone: 405-748-4726
  • Fax: 405-936-5621
Mailing address:
  • Phone: 62-624-0444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code170300000X
TaxonomyGenetic Counselor (M.S.)
License Number190
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: