Individual
DR. KATHLEEN SHEPHERD KOLJACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
701 E MAIN ST, JENKS, OK 74037-4316
(918) 298-2264
(918) 298-0923
Mailing address
701 E MAIN ST, JENKS, OK 74037-4316
(918) 298-2264
(918) 298-0923
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
15092
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100056450D
—
OK
Enumeration date
05/19/2006
Last updated
05/01/2014
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