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General NPI Number Information
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NPI Number | 1023020641
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Entity Type | Individual
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Provider Name | KYLE W RICKNER M.D.
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Gender | Male
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Dates
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Enumeration Date | 08/12/2006
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Last Update Date | 03/17/2016
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Provider Practice Location Address
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Address Line | 11 PALM AVE
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City | YUKON
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State | OK
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Zip | 73099-5645
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Country | US
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Telephone | 405-350-5140
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Fax |
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Provider Business Mailing Address
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Address Line | 1820 COMMONS CR SUITE A
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City | YUKON
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State | OK
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Zip | 73099-9518
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Country | US
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Telephone | 405-265-2778
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Fax | 405-494-7274
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 21266
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License Number State | OK
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