Healthcare Provider Details

I. General information

NPI: 1689794653
Provider Name (Legal Business Name): KATHRYN ANNETTE WINICK M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2007
Last Update Date: 02/21/2022
Certification Date: 02/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9031 SW 29TH ST
OKLAHOMA CITY OK
73179-2818
US

IV. Provider business mailing address

9031 SW 29TH ST
OKLAHOMA CITY OK
73179-2818
US

V. Phone/Fax

Practice location:
  • Phone: 405-512-6950
  • Fax:
Mailing address:
  • Phone: 405-512-6950
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0105X
TaxonomyClinical Pathology/Laboratory Medicine Physician
License NumberP8326
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207ZP0105X
TaxonomyClinical Pathology/Laboratory Medicine Physician
License NumberME117824
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code207ZP0105X
TaxonomyClinical Pathology/Laboratory Medicine Physician
License Number27901
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: