Provider Demographics
NPI:1588211361
Name:HUYNH, KATHY (PA-C)
Entity Type:Individual
Prefix:MS
First Name:KATHY
Middle Name:
Last Name:HUYNH
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4704 SE 47TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73135-3212
Mailing Address - Country:US
Mailing Address - Phone:405-845-3171
Mailing Address - Fax:
Practice Address - Street 1:3300 S ASPEN AVE STE A
Practice Address - Street 2:
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74012-7501
Practice Address - Country:US
Practice Address - Phone:918-770-4599
Practice Address - Fax:918-770-7060
Is Sole Proprietor?:No
Enumeration Date:2019-08-26
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant