Provider Demographics
NPI:1063289122
Name:KCT HEALTH CARE PLLC
Entity type:Organization
Organization Name:KCT HEALTH CARE PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER/NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:KATY
Authorized Official - Middle Name:ERIN
Authorized Official - Last Name:TROTTER
Authorized Official - Suffix:
Authorized Official - Credentials:APRN-CNP
Authorized Official - Phone:479-209-6400
Mailing Address - Street 1:4211 W 84TH ST
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74132-3032
Mailing Address - Country:US
Mailing Address - Phone:479-209-6400
Mailing Address - Fax:
Practice Address - Street 1:5555 E 71ST ST STE 7250
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-6554
Practice Address - Country:US
Practice Address - Phone:918-492-8301
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-08
Last Update Date:2023-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty