Provider Demographics
NPI:1639298383
Name:SKAGGS, KALYN
Entity Type:Individual
Prefix:MS
First Name:KALYN
Middle Name:
Last Name:SKAGGS
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 1:3713 W. FOREST TRAIL CT.
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:OK
Mailing Address - Zip Code:74074
Mailing Address - Country:US
Mailing Address - Phone:580-747-2312
Mailing Address - Fax:
Practice Address - Street 1:800 E 6TH AVE
Practice Address - Street 2:SUITE B
Practice Address - City:STILLWATER
Practice Address - State:OK
Practice Address - Zip Code:74074-3732
Practice Address - Country:US
Practice Address - Phone:405-372-1250
Practice Address - Fax:405-377-5215
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NONE171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator