Provider Demographics
NPI:1437525532
Name:BACHELDER, KILEY RENEAH (BS)
Entity Type:Individual
Prefix:
First Name:KILEY
Middle Name:RENEAH
Last Name:BACHELDER
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 N GRANT ST
Mailing Address - Street 2:
Mailing Address - City:CORDELL
Mailing Address - State:OK
Mailing Address - Zip Code:73632-2418
Mailing Address - Country:US
Mailing Address - Phone:580-660-1362
Mailing Address - Fax:
Practice Address - Street 1:2 WICHERSHAM DRIVE
Practice Address - Street 2:
Practice Address - City:MANGUM
Practice Address - State:OK
Practice Address - Zip Code:73554
Practice Address - Country:US
Practice Address - Phone:580-782-3337
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-12
Last Update Date:2015-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator