Provider Demographics
NPI:1225844350
Name:KIRKENDALL, MATTHEW (RN)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:KIRKENDALL
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13872 HUMMINGBIRD CIR
Mailing Address - Street 2:
Mailing Address - City:CHOCTAW
Mailing Address - State:OK
Mailing Address - Zip Code:73020-7114
Mailing Address - Country:US
Mailing Address - Phone:405-255-5458
Mailing Address - Fax:
Practice Address - Street 1:13872 HUMMINGBIRD CIR
Practice Address - Street 2:
Practice Address - City:CHOCTAW
Practice Address - State:OK
Practice Address - Zip Code:73020-7114
Practice Address - Country:US
Practice Address - Phone:405-255-5458
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-04
Last Update Date:2024-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0096674163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice