Individual
KYLE FANNING
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1401 SW 34TH ST STE 200, MOORE, OK 73160-3059
(405) 793-1188
(405) 793-0492
Mailing address
5300 N INDEPENDENCE AVE, 280, OKLAHOMA CITY, OK 73112-5556
(405) 793-1188
(405) 793-0492
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
17631
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100197770B
—
OK
05
—
100197770C
—
OK
Enumeration date
06/15/2006
Last updated
03/19/2019
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