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General NPI Number Information
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NPI Number | 1831583137
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Entity Type | Individual
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Provider Name | KYLIE MISHAEL SELF BSN, RN
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Gender | Female
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Dates
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Enumeration Date | 03/24/2015
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Last Update Date | 09/21/2017
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Provider Practice Location Address
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Address Line | 1001 W MAIN ST
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City | DURANT
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State | OK
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Zip | 74701-5038
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Country | US
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Telephone | 580-924-7330
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Fax |
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Provider Business Mailing Address
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Address Line | 82 BLUE STEM ROAD
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City | CADDO
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State | OK
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Zip | 74729-3019
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Country | US
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Telephone | 580-434-2719
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | R 0110761
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License Number State | OK
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