Individual
MS. ELSIE M LYTLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4606 S GARNETT RD, #302, TULSA, OK 74146-5231
(918) 664-6544
(918) 664-0668
Mailing address
4606 S GARNETT RD, #302, TULSA, OK 74146-5231
(918) 664-6544
(918) 664-0668
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
NONE REQUIRED
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0259450001
RR MEDICARE
OK
05
—
100810010-A
—
OK
01
—
123441716
ARK MEDICAID
AR
01
—
200302570A
KANSAS MEDICAL ASSOC MCD
KS
01
—
323088005
MISSOURI MEDICAID
MO
01
—
731385829
TRICARE
OK
Enumeration date
02/03/2007
Last updated
06/17/2008
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