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General NPI Number Information
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NPI Number | 1053172163
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Entity Type | Individual
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Provider Name | KAYLA NICOLE MATHERLY RDMS AB, OB/GYN
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Gender | Female
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Dates
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Enumeration Date | 01/17/2024
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Last Update Date | 01/17/2024
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Provider Practice Location Address
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Address Line | 873 S MUSTANG RD
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City | YUKON
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State | OK
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Zip | 73099-6779
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Country | US
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Telephone | 405-990-0631
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Fax | 405-251-8692
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Provider Business Mailing Address
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Address Line | 873 S MUSTANG RD
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City | YUKON
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State | OK
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Zip | 73099-6779
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Country | US
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Telephone | 405-990-0631
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Fax | 405-251-8692
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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 | 2085U0001X
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Taxonomy Name | Diagnostic Ultrasound Physician
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License Number | 237570
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License Number State | OK
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