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General NPI Number Information
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NPI Number | 1811719974
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Entity Type | Individual
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Provider Name | KYYAAH MICHELLE THOMPSON
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Gender | Female
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Dates
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Enumeration Date | 10/29/2024
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Last Update Date | 10/29/2024
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Provider Practice Location Address
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Address Line | 437 W WILSHIRE BLVD
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City | OKLAHOMA CITY
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State | OK
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Zip | 73116-7778
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Country | US
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Telephone | 405-326-8700
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Fax | 405-751-0110
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Provider Business Mailing Address
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Address Line | 4509 SE 48TH ST
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City | OKLAHOMA CITY
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State | OK
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Zip | 73135-3213
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Country | US
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Telephone | 405-693-7850
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Fax |
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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 | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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