Healthcare Provider Details

I. General information

NPI: 1023682135
Provider Name (Legal Business Name): KRISTEN MACDOUGALL BYBEE AU.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KRISTEN LEIGH MACDOUGALL

II. Dates (important events)

Enumeration Date: 05/14/2021
Last Update Date: 05/14/2021
Certification Date: 05/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 CHILDRENS AVE # 8C
OKLAHOMA CITY OK
73104-4637
US

IV. Provider business mailing address

825 NE 10TH ST STE 4200
OKLAHOMA CITY OK
73104-5417
US

V. Phone/Fax

Practice location:
  • Phone: 405-271-2662
  • Fax:
Mailing address:
  • Phone: 405-271-1368
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number5551
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: