Provider Demographics
NPI:1639930472
Name:KUEHNE, KAITLIN NIKOLE (PHARMD)
Entity Type:Individual
Prefix:
First Name:KAITLIN
Middle Name:NIKOLE
Last Name:KUEHNE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1417 PARTRIDGE LN
Mailing Address - Street 2:
Mailing Address - City:CORDELL
Mailing Address - State:OK
Mailing Address - Zip Code:73632-1625
Mailing Address - Country:US
Mailing Address - Phone:580-660-5556
Mailing Address - Fax:
Practice Address - Street 1:220 S HIGHWAY 97
Practice Address - Street 2:
Practice Address - City:SAND SPRINGS
Practice Address - State:OK
Practice Address - Zip Code:74063-6571
Practice Address - Country:US
Practice Address - Phone:918-245-9523
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-18
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK20357183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist