Healthcare Provider Details

I. General information

NPI: 1992634604
Provider Name (Legal Business Name): KATELYN RILEY CAVINESS MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2026
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1445 HEALTH CENTER PKWY
YUKON OK
73099-6492
US

IV. Provider business mailing address

1445 HEALTH CENTER PKWY
YUKON OK
73099-6492
US

V. Phone/Fax

Practice location:
  • Phone: 405-578-9770
  • Fax: 405-265-2929
Mailing address:
  • Phone: 405-578-9700
  • Fax: 405-265-2929

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberCF880
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: