Provider Demographics
NPI:1407561988
Name:FOOTE, KAYLYNN
Entity Type:Individual
Prefix:MRS
First Name:KAYLYNN
Middle Name:
Last Name:FOOTE
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 1:1130 E LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:SAPULPA
Mailing Address - State:OK
Mailing Address - Zip Code:74066-4627
Mailing Address - Country:US
Mailing Address - Phone:918-417-0615
Mailing Address - Fax:
Practice Address - Street 1:1130 E LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:SAPULPA
Practice Address - State:OK
Practice Address - Zip Code:74066-4627
Practice Address - Country:US
Practice Address - Phone:918-417-0615
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-18
Last Update Date:2023-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator