Provider Demographics
NPI:1538455951
Name:SUMMERS, KAYLI NICOLE (BA)
Entity type:Individual
Prefix:MISS
First Name:KAYLI
Middle Name:NICOLE
Last Name:SUMMERS
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5553 S PEORIA AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74105-6800
Mailing Address - Country:US
Mailing Address - Phone:918-895-6917
Mailing Address - Fax:918-779-4556
Practice Address - Street 1:5553 S PEORIA AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74105-6800
Practice Address - Country:US
Practice Address - Phone:918-895-6917
Practice Address - Fax:918-779-4556
Is Sole Proprietor?:No
Enumeration Date:2011-06-23
Last Update Date:2011-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health