Provider Demographics
NPI:1609177997
Name:CAPPS, KAYLA DAWN (DOP)
Entity Type:Individual
Prefix:MRS
First Name:KAYLA
Middle Name:DAWN
Last Name:CAPPS
Suffix:
Gender:F
Credentials:DOP
Other - Prefix:
Other - First Name:KAYLA
Other - Middle Name:DAWN
Other - Last Name:MANNING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DOP
Mailing Address - Street 1:1334 N LANSING AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74106-5907
Mailing Address - Country:US
Mailing Address - Phone:918-295-6130
Mailing Address - Fax:918-295-6199
Practice Address - Street 1:1334 N LANSING AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74106-5907
Practice Address - Country:US
Practice Address - Phone:918-295-6130
Practice Address - Fax:918-295-6199
Is Sole Proprietor?:No
Enumeration Date:2010-11-03
Last Update Date:2010-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK14079183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist