Healthcare Provider Details

I. General information

NPI: 1891772307
Provider Name (Legal Business Name): KENDALL LITTLE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/27/2005
Last Update Date: 08/25/2021
Certification Date: 08/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13309 UPPER POND CT
OKLAHOMA CITY OK
73142-6215
US

IV. Provider business mailing address

13309 UPPER POND CT
OKLAHOMA CITY OK
73142-6215
US

V. Phone/Fax

Practice location:
  • Phone: 405-708-2592
  • Fax:
Mailing address:
  • Phone: 405-708-2592
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number23444
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number23444
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: