Provider Demographics
NPI:1689638207
Name:MCKIBBIN, JEFFREY LYNN (ATC)
Entity Type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:LYNN
Last Name:MCKIBBIN
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 N UNIVERSITY DR
Mailing Address - Street 2:BOX 189, WANTLAND HALL
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73034-5207
Mailing Address - Country:US
Mailing Address - Phone:405-974-2959
Mailing Address - Fax:405-974-5310
Practice Address - Street 1:100 N UNIVERSITY DR
Practice Address - Street 2:BOX 189, WANTLAND HALL
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73034-5207
Practice Address - Country:US
Practice Address - Phone:405-974-2959
Practice Address - Fax:405-974-5310
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKAT232255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer