Healthcare Provider Details

I. General information

NPI: 1114472594
Provider Name (Legal Business Name): KELSEY HUKILL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2016
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11740 E 21ST ST
TULSA OK
74129-1820
US

IV. Provider business mailing address

11740 E 21ST ST
TULSA OK
74129
US

V. Phone/Fax

Practice location:
  • Phone: 918-636-2934
  • Fax:
Mailing address:
  • Phone: 918-636-2934
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: