Healthcare Provider Details

I. General information

NPI: 1386315182
Provider Name (Legal Business Name): KAYLA NOEL RRT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2021
Last Update Date: 09/22/2021
Certification Date: 09/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7647 S EVANSTON AVE
TULSA OK
74136-8764
US

IV. Provider business mailing address

4305 W OKMULGEE ST APT 102
MUSKOGEE OK
74401-4652
US

V. Phone/Fax

Practice location:
  • Phone: 918-671-4419
  • Fax:
Mailing address:
  • Phone: 918-348-9798
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2279G1100X
TaxonomyGeneral Care Registered Respiratory Therapist
License Number4340
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: