Provider Demographics
NPI:1427046135
Name:PRIEST, KENNETH D (MD)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:D
Last Name:PRIEST
Suffix:
Gender:M
Credentials:MD
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 272606
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73137-2606
Mailing Address - Country:US
Mailing Address - Phone:405-775-9350
Mailing Address - Fax:405-775-9360
Practice Address - Street 1:3048 SW 89TH ST
Practice Address - Street 2:SUITE A
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73159-6385
Practice Address - Country:US
Practice Address - Phone:405-703-1302
Practice Address - Fax:405-703-1649
Is Sole Proprietor?:No
Enumeration Date:2005-10-07
Last Update Date:2011-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK19107207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK4647871OtherAETNA
OK358460300OtherDEPT OF LABOR
OK100151370AMedicaid
OK4647871OtherAETNA
OK358460300OtherDEPT OF LABOR
OK4647871OtherAETNA