Provider Demographics
NPI:1578338307
Name:CLODFELTER, KADE AARON
Entity Type:Individual
Prefix:
First Name:KADE
Middle Name:AARON
Last Name:CLODFELTER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5739 E 65TH ST
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-2721
Mailing Address - Country:US
Mailing Address - Phone:918-990-1014
Mailing Address - Fax:
Practice Address - Street 1:5739 E 65TH ST
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-2721
Practice Address - Country:US
Practice Address - Phone:918-990-1014
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-21
Last Update Date:2023-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR081017333175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175T00000XOther Service ProvidersPeer SpecialistGroup - Multi-Specialty