Provider Demographics
NPI:1396482402
Name:KIEHL, KEGAN MICHELLE
Entity type:Individual
Prefix:
First Name:KEGAN
Middle Name:MICHELLE
Last Name:KIEHL
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 1:23 N 8TH ST
Mailing Address - Street 2:
Mailing Address - City:DUNCAN
Mailing Address - State:OK
Mailing Address - Zip Code:73533-4601
Mailing Address - Country:US
Mailing Address - Phone:888-480-6628
Mailing Address - Fax:855-253-2083
Practice Address - Street 1:23 N 8TH ST
Practice Address - Street 2:
Practice Address - City:DUNCAN
Practice Address - State:OK
Practice Address - Zip Code:73533-4601
Practice Address - Country:US
Practice Address - Phone:888-480-6628
Practice Address - Fax:855-253-2083
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-19
Last Update Date:2022-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator