Healthcare Provider Details

I. General information

NPI: 1568687515
Provider Name (Legal Business Name): KAY SEE LASLEY DPH, MS, LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/16/2007
Last Update Date: 02/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6328 E 72ND ST APT 514
TULSA OK
74136-6932
US

IV. Provider business mailing address

6328 E 72ND ST APT 514
TULSA OK
74136-6932
US

V. Phone/Fax

Practice location:
  • Phone: 918-477-9052
  • Fax: 918-492-8245
Mailing address:
  • Phone: 918-477-9052
  • Fax: 918-492-8245

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1835X0200X
TaxonomyOncology Pharmacist
License Number9179
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number9179
License Number StateOK
# 3
Primary TaxonomyN
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number9179
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: