Healthcare Provider Details

I. General information

NPI: 1568241297
Provider Name (Legal Business Name): MS. KYMBERLEA ANNE WELCH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2023
Last Update Date: 09/22/2023
Certification Date: 09/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6333 E SKELLY DR
TULSA OK
74135-6106
US

IV. Provider business mailing address

PO BOX 593
HOMINY OK
74035-0593
US

V. Phone/Fax

Practice location:
  • Phone: 918-565-3240
  • Fax:
Mailing address:
  • Phone: 918-565-3240
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: