Individual
KATHY SONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
356110 E 930 RD, STROUD, OK 74079-5184
(918) 968-9531
Mailing address
2868 ACTON RD, VESTAVIA, AL 35243-2502
(205) 379-6075
(866) 702-0880
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
1287
AL
363AM0700X
Medical Physician Assistant
2160
OK
Other
Enumeration date
09/17/2012
Last updated
09/03/2019
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