Individual
KEMPTON MICHAEL REYNOLDS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1212 REYNOLDS AVE, POTEAU, OK 74953-4724
(918) 649-0172
Mailing address
1212 REYNOLDS AVE, POTEAU, OK 74953-4724
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000000000
—
OK
Enumeration date
01/08/2018
Last updated
01/08/2018
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