Provider Demographics
NPI:1225005895
Name:VINEYARD, KYRA JEAN (DO)
Entity type:Individual
Prefix:
First Name:KYRA
Middle Name:JEAN
Last Name:VINEYARD
Suffix:
Gender:
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11917 S NORWOOD AVE STE 212
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74137-5509
Mailing Address - Country:US
Mailing Address - Phone:918-392-5555
Mailing Address - Fax:918-392-5566
Practice Address - Street 1:11917 S. NORWOOD AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74137
Practice Address - Country:US
Practice Address - Phone:918-392-5555
Practice Address - Fax:918-392-5566
Is Sole Proprietor?:No
Enumeration Date:2006-03-02
Last Update Date:2025-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3998207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100102730AMedicaid
OK248628505Medicare PIN
OK100102730AMedicaid
OK100102730AMedicaid