Provider Demographics
NPI:1962201715
Name:MCCOLLOUGH, KYLEE (FNP-C)
Entity type:Individual
Prefix:
First Name:KYLEE
Middle Name:
Last Name:MCCOLLOUGH
Suffix:
Gender:
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3801 WHIPPOORWILL LN
Mailing Address - Street 2:
Mailing Address - City:ENID
Mailing Address - State:OK
Mailing Address - Zip Code:73703-1480
Mailing Address - Country:US
Mailing Address - Phone:580-729-0955
Mailing Address - Fax:
Practice Address - Street 1:108 W RANDOLPH AVE
Practice Address - Street 2:
Practice Address - City:ENID
Practice Address - State:OK
Practice Address - Zip Code:73701-4005
Practice Address - Country:US
Practice Address - Phone:580-402-8600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-12
Last Update Date:2025-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK222410363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily