Provider Demographics
NPI:1629377825
Name:KITCHENS, TREVOR KYLE (MD)
Entity Type:Individual
Prefix:DR
First Name:TREVOR
Middle Name:KYLE
Last Name:KITCHENS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:5300 N INDEPENDENCE AVE
Mailing Address - Street 2:SUITE 280
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-5556
Mailing Address - Country:US
Mailing Address - Phone:918-786-2243
Mailing Address - Fax:918-787-3401
Practice Address - Street 1:1001 E 18TH ST
Practice Address - Street 2:
Practice Address - City:GROVE
Practice Address - State:OK
Practice Address - Zip Code:74344-2907
Practice Address - Country:US
Practice Address - Phone:918-786-2243
Practice Address - Fax:918-787-3401
Is Sole Proprietor?:No
Enumeration Date:2011-03-28
Last Update Date:2017-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK28561207Q00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine