Individual
KYLEE SHAE RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
35783 S OAKRIDGE DR, PARK HILL, OK 74451
(918) 315-2766
Mailing address
35783 S OAKRIDGE DR, PARK HILL, OK 74451-2112
(918) 315-2766
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
12/19/2019
Last updated
06/27/2024
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