Provider Demographics
NPI:1952733073
Name:WHITTEN, KYLE FOSTER (ATC)
Entity Type:Individual
Prefix:
First Name:KYLE
Middle Name:FOSTER
Last Name:WHITTEN
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6475 S YALE AVE
Mailing Address - Street 2:SUITE 301
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-7816
Mailing Address - Country:US
Mailing Address - Phone:918-494-9300
Mailing Address - Fax:918-494-9355
Practice Address - Street 1:6475 S YALE AVE
Practice Address - Street 2:SUITE 301
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-7816
Practice Address - Country:US
Practice Address - Phone:918-494-9300
Practice Address - Fax:918-494-9355
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-31
Last Update Date:2018-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK7722255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK772OtherOKLAHOMA STATE ATHLETIC TRAINING LICENSE NUMBER