Provider Demographics
NPI:1053068726
Name:PRYOR, KAITLEN ELIZABETH
Entity Type:Individual
Prefix:
First Name:KAITLEN
Middle Name:ELIZABETH
Last Name:PRYOR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 735
Mailing Address - Street 2:
Mailing Address - City:STIGLER
Mailing Address - State:OK
Mailing Address - Zip Code:74462-0735
Mailing Address - Country:US
Mailing Address - Phone:918-967-8491
Mailing Address - Fax:918-967-2552
Practice Address - Street 1:1407 NE D ST STE B
Practice Address - Street 2:
Practice Address - City:STIGLER
Practice Address - State:OK
Practice Address - Zip Code:74462-2815
Practice Address - Country:US
Practice Address - Phone:918-967-8491
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-03
Last Update Date:2022-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist