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NPI Code Detail

MEDICARE: KYLE JONBRANDON TAPP

MEDICARE: KYLE JONBRANDON TAPP
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
1171W00000XContractorNONE REQUIREDOK

General Provider Information

NPI Number : 1457583411
Entity Type Code : Individual
Provider Name (Legal Business Name) : KYLE JONBRANDON TAPP
Provider Business Mailing Address
First Line : 1021 NW 6TH ST
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73106-7202
Country : US
Telephone Number : 405-819-3241
Fax Number : 405-609-2997
Provider Business Practice Location Address
First Line : 1021 NW 6TH ST
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73106-7202
Country : US
Telephone Number : 405-819-3241
Fax Number : 405-609-2997
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/10/2009
Last Update Date : 08/10/2009

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Directions to “ KYLE JONBRANDON TAPP ” Practice Location

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