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General NPI Number Information
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NPI Number | 1205033446
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Entity Type | Individual
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Provider Name | KYLA MARIE LUSSIER M.D.
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Gender | Female
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Dates
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Enumeration Date | 06/29/2007
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Last Update Date | 07/09/2012
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Provider Practice Location Address
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Address Line | 1755 N HIGHWAY 66 SUITE F
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City | CATOOSA
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State | OK
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Zip | 74015-2409
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Country | US
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Telephone | 918-739-4885
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Fax | 918-739-4886
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Provider Business Mailing Address
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Address Line | PO BOX 2035
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City | CATOOSA
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State | OK
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Zip | 74015-2926
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Country | US
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Telephone | 918-739-4885
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Fax | 918-739-4886
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 25858
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License Number State | OK
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