# KYLE A. WILSON, D.O., LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1376051227
- **Authorized official:** KYLE A WILSON DO (MANAGING MEMBER)
- **Authorized official phone:** (918) 749-1413

## Contact information

- **Practice address:** 1725 E 19TH ST STE 401, TULSA, OK 74104
- **Practice address phone:** (918) 749-1413
- **Practice address fax:** (918) 749-0234
- **Mailing address:** 1725 E 19TH ST STE 401, TULSA, OK 74104-5409
- **Mailing address phone:** (918) 749-1413
- **Mailing address fax:** (918) 749-0234

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207V00000X | Obstetrics & Gynecology Physician | — | NULL | Yes |
| 207V00000X | Obstetrics & Gynecology Physician | — | — | Yes |

## Other

- **Enumeration date:** 01/12/2018
- **Last updated:** 07/11/2022

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 200774440A | — | OK |