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NPI Code Detail

MEDICARE: DR. KAYLA LAKIN-SOUTHERN DO

MEDICARE:  DR. KAYLA  LAKIN-SOUTHERN  DO
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207P00000XEmergency Medicine Physician2306OK
2207Q00000XFamily Medicine Physician2306OK

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1930108407OTHEROKMEDICARE RAILROAD

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1205815537
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. KAYLA LAKIN-SOUTHERN DO
Provider Business Mailing Address
First Line : 4209 S REDWOOD AVE
Second Line :
City : BROKEN ARROW
State : OK
Zip : 74011-1473
Country : US
Telephone Number : 918-521-3688
Fax Number :
Provider Business Practice Location Address
First Line : 10109 E 79TH ST
Second Line :
City : TULSA
State : OK
Zip : 74133-4564
Country : US
Telephone Number : 918-521-3688
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/13/2006
Last Update Date : 10/16/2019

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Directions to “ DR. KAYLA LAKIN-SOUTHERN DO” Practice Location

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