Healthcare Provider Details

I. General information

NPI: 1225527476
Provider Name (Legal Business Name): PAU KHAN KAP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2018
Last Update Date: 05/20/2024
Certification Date: 05/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2448 E 81ST ST STE 4460
TULSA OK
74137-4251
US

IV. Provider business mailing address

2448 E 81ST ST STE 4460
TULSA OK
74137-4251
US

V. Phone/Fax

Practice location:
  • Phone: 918-600-2966
  • Fax: 918-600-2965
Mailing address:
  • Phone: 918-600-2966
  • Fax: 918-600-2965

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number10389
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: