Provider Demographics
NPI:1588892285
Name:KUYKENDALL DERMATOLOGY, PC
Entity type:Organization
Organization Name:KUYKENDALL DERMATOLOGY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:D
Authorized Official - Last Name:KUYKENDALL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:405-301-8010
Mailing Address - Street 1:1218 E 9TH ST
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73034-5952
Mailing Address - Country:US
Mailing Address - Phone:405-301-8010
Mailing Address - Fax:888-720-0860
Practice Address - Street 1:1218 E 9TH ST
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73034-5952
Practice Address - Country:US
Practice Address - Phone:405-301-8010
Practice Address - Fax:888-720-0860
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-01
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK23494207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK1588892285OtherNPI
OK242722202Medicare PIN