Provider Demographics
NPI:1912686114
Name:GIVENS, KERRY LYNN
Entity Type:Individual
Prefix:MS
First Name:KERRY
Middle Name:LYNN
Last Name:GIVENS
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:PO BOX 8
Mailing Address - Street 2:
Mailing Address - City:MAUD
Mailing Address - State:OK
Mailing Address - Zip Code:74854-0008
Mailing Address - Country:US
Mailing Address - Phone:405-374-1225
Mailing Address - Fax:866-201-3530
Practice Address - Street 1:32018 HWY 59
Practice Address - Street 2:
Practice Address - City:MAUD
Practice Address - State:OK
Practice Address - Zip Code:74854
Practice Address - Country:US
Practice Address - Phone:405-374-1225
Practice Address - Fax:866-201-3530
Is Sole Proprietor?:No
Enumeration Date:2023-07-14
Last Update Date:2023-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach