Individual
MR. BRAXTON KYLE HUCKABEE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CNP
Contact information
Practice address
4802 S 109TH EAST AVE, TULSA, OK 74146-5822
(918) 392-1400
Mailing address
701 W 101ST PL S APT 2101, JENKS, OK 74037-3582
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
Primary
201762
OK
Other
Enumeration date
10/28/2021
Last updated
10/28/2021
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