Provider Demographics
NPI:1679194765
Name:CLIFT, KAYLI BREANNE
Entity Type:Individual
Prefix:
First Name:KAYLI
Middle Name:BREANNE
Last Name:CLIFT
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:PO BOX 673
Mailing Address - Street 2:
Mailing Address - City:VALLIANT
Mailing Address - State:OK
Mailing Address - Zip Code:74764-0673
Mailing Address - Country:US
Mailing Address - Phone:580-203-3600
Mailing Address - Fax:833-402-9799
Practice Address - Street 1:300 N DALTON ST
Practice Address - Street 2:
Practice Address - City:VALLIANT
Practice Address - State:OK
Practice Address - Zip Code:74764-8029
Practice Address - Country:US
Practice Address - Phone:580-203-3600
Practice Address - Fax:833-402-9799
Is Sole Proprietor?:No
Enumeration Date:2020-04-30
Last Update Date:2020-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator