MEDICARE: KAYLEE D OSBORNE

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
1	104100000X	Social Worker	7608-P	OK

General Provider Information

NPI Number	:	1487253456
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAYLEE D OSBORNE

Provider Business Mailing Address
First Line	:	1617 NW 144TH TER
Second Line	:
City	:	EDMOND
State	:	OK
Zip	:	73013-2504
Country	:	US
Telephone Number	:	405-740-2893
Fax Number	:

Provider Business Practice Location Address
First Line	:	2801 PARKLAWN DR STE 201
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73110-4229
Country	:	US
Telephone Number	:	405-733-5437
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/21/2020
Last Update Date	:	10/21/2020

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Directions to “ KAYLEE D OSBORNE ” Practice Location

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