Individual
DR. KAYLA LAKIN-SOUTHERN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
10109 E 79TH ST, TULSA, OK 74133-4564
(918) 521-3688
Mailing address
4209 S REDWOOD AVE, BROKEN ARROW, OK 74011-1473
(918) 521-3688
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
2306
OK
207Q00000X
Family Medicine Physician
Primary
2306
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100227370A
—
OK
01
—
930108407
MEDICARE RAILROAD
OK
Enumeration date
01/13/2006
Last updated
10/16/2019
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