Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TR0400X | Rehabilitation Psychologist | OK |
NPI | 1265843049 |
---|---|
Provider Name | Kevin Adkison |
First Address | Tishomingo, OK 73460-0201 |
Second Address | Tishomingo, OK 73460-2339 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/05/2014 |
Last Update Date | 14/05/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
UNKNOWN | (05) | OK |