Provider Demographics
NPI:1700505849
Name:PIXLEY, KAITLYN MARIE
Entity Type:Individual
Prefix:MISS
First Name:KAITLYN
Middle Name:MARIE
Last Name:PIXLEY
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 1:500 CENTRAL PARK DR
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73105-1705
Mailing Address - Country:US
Mailing Address - Phone:918-510-2802
Mailing Address - Fax:
Practice Address - Street 1:UNIVERSITY OF OKLAHOMA COLLEGE OF MEDICINE
Practice Address - Street 2:800 STANTON L. YOUNG BLVD
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73104
Practice Address - Country:US
Practice Address - Phone:405-271-2316
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-23
Last Update Date:2022-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program