Individual
TRACY ADELLE KIDWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
1800 S DOUGLAS BLVD, MIDWEST CITY, OK 73130-6224
(405) 741-7722
(405) 741-7757
Mailing address
1800 S DOUGLAS BLVD, MIDWEST CITY, OK 73130-6224
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
3809
OK
Other
Enumeration date
01/05/2006
Last updated
06/10/2022
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