Provider Demographics
NPI:1205174307
Name:MORRIS, KYNDRA DAWN (PA-C)
Entity type:Individual
Prefix:
First Name:KYNDRA
Middle Name:DAWN
Last Name:MORRIS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2290 COMMUNITY PL
Mailing Address - Street 2:
Mailing Address - City:HARRAH
Mailing Address - State:OK
Mailing Address - Zip Code:73045-1119
Mailing Address - Country:US
Mailing Address - Phone:580-504-2057
Mailing Address - Fax:
Practice Address - Street 1:13128 N MACARTHUR BLVD
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73142-3017
Practice Address - Country:US
Practice Address - Phone:405-945-0001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-23
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC0010-04956363A00000X
OK2205363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant