Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | 4586 | OK |
NPI | 1023291457 |
---|---|
Provider Name | Cynthia Kay Wilkett |
First Address | Tulsa, OK 74104-4636 |
Second Address | Tulsa, OK 74104-4636 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/12/2007 |
Last Update Date | 18/04/2011 |