Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081S0010X | Sports Medicine | 900 | OK |
Y | 213ES0000X | Sports Medicine | 900 | OK |
NPI | 1346698446 |
---|---|
Provider Name | Kyler King |
First Address | Independence, KS 67301 |
Second Address | Bartlesville, OK 74006-6233 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/05/2016 |
Last Update Date | 31/05/2016 |