Provider Demographics
NPI:1790040350
Name:CLIFFT, KYLAH CHEY ANNE (NP)
Entity Type:Individual
Prefix:
First Name:KYLAH
Middle Name:CHEY ANNE
Last Name:CLIFFT
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 E CLARK BASS BLVD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:MCALESTER
Mailing Address - State:OK
Mailing Address - Zip Code:74501-4269
Mailing Address - Country:US
Mailing Address - Phone:918-423-8200
Mailing Address - Fax:918-423-8222
Practice Address - Street 1:4 E CLARK BASS BLVD
Practice Address - Street 2:SUITE 203
Practice Address - City:MCALESTER
Practice Address - State:OK
Practice Address - Zip Code:74501-4269
Practice Address - Country:US
Practice Address - Phone:918-423-8200
Practice Address - Fax:918-423-8222
Is Sole Proprietor?:No
Enumeration Date:2012-07-10
Last Update Date:2012-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK90181363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner