Provider Demographics
NPI:1164478541
Name:WHITTINGTON, KINION (DO)
Entity Type:Individual
Prefix:
First Name:KINION
Middle Name:
Last Name:WHITTINGTON
Suffix:
Gender:M
Credentials:DO
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 579
Mailing Address - Street 2:
Mailing Address - City:DURANT
Mailing Address - State:OK
Mailing Address - Zip Code:74702-0579
Mailing Address - Country:US
Mailing Address - Phone:580-920-2122
Mailing Address - Fax:580-920-9976
Practice Address - Street 1:1706 DELIVERY LN
Practice Address - Street 2:
Practice Address - City:DURANT
Practice Address - State:OK
Practice Address - Zip Code:74701-2292
Practice Address - Country:US
Practice Address - Phone:580-920-2122
Practice Address - Fax:580-920-9976
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-26
Last Update Date:2012-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3723174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
H31686Medicare UPIN