Provider Demographics
NPI:1063977395
Name:HANKINS, KYLE RAY
Entity type:Individual
Prefix:
First Name:KYLE
Middle Name:RAY
Last Name:HANKINS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:313 E EDWARDS ST
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73034-4528
Mailing Address - Country:US
Mailing Address - Phone:580-309-3008
Mailing Address - Fax:
Practice Address - Street 1:313 E EDWARDS ST
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73034-4528
Practice Address - Country:US
Practice Address - Phone:580-309-3008
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-31
Last Update Date:2019-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist