Provider Demographics
NPI:1487041646
Name:TIPTON, KHEYOURA
Entity Type:Individual
Prefix:
First Name:KHEYOURA
Middle Name:
Last Name:TIPTON
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 1:401 W COVELL RD
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73003-2000
Mailing Address - Country:US
Mailing Address - Phone:773-972-7304
Mailing Address - Fax:
Practice Address - Street 1:10948 N MAY AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120-6223
Practice Address - Country:US
Practice Address - Phone:773-972-7304
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-24
Last Update Date:2015-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health