Provider Demographics
NPI:1578830006
Name:CYBULSKI, KELLE DEON
Entity Type:Individual
Prefix:MRS
First Name:KELLE
Middle Name:DEON
Last Name:CYBULSKI
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 1:917 RANCH RD N
Mailing Address - Street 2:
Mailing Address - City:ALTUS
Mailing Address - State:OK
Mailing Address - Zip Code:73521-1026
Mailing Address - Country:US
Mailing Address - Phone:580-235-9259
Mailing Address - Fax:
Practice Address - Street 1:917 RANCH RD N
Practice Address - Street 2:
Practice Address - City:ALTUS
Practice Address - State:OK
Practice Address - Zip Code:73521-1026
Practice Address - Country:US
Practice Address - Phone:580-235-9259
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-29
Last Update Date:2011-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator