Healthcare Provider Details

I. General information

NPI: 1609642818
Provider Name (Legal Business Name): KAITLYN RAYNE MORRISON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/29/2023
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

212 N PIERCE AVE
WAGONER OK
74467-4128
US

IV. Provider business mailing address

1603 N ABERDEEN ST
MUSKOGEE OK
74403-7306
US

V. Phone/Fax

Practice location:
  • Phone: 918-485-3022
  • Fax:
Mailing address:
  • Phone: 918-882-9584
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: