Provider Demographics
NPI:1285033449
Name:KUYKENDALL, KLINTON KYLE (MED, ATC, LAT)
Entity Type:Individual
Prefix:
First Name:KLINTON
Middle Name:KYLE
Last Name:KUYKENDALL
Suffix:
Gender:M
Credentials:MED, ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7412 KAYLEE WAY
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73132-4802
Mailing Address - Country:US
Mailing Address - Phone:817-913-7269
Mailing Address - Fax:
Practice Address - Street 1:7412 KAYLEE WAY
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73132-4802
Practice Address - Country:US
Practice Address - Phone:817-913-7269
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-13
Last Update Date:2017-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT47872255A2300X
OK8692255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer