Individual
KASEY LANE GILL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1111 W 17TH ST, TULSA, OK 74107-1886
(405) 550-9210
Mailing address
3962 BRIAR LN, TAHLEQUAH, OK 74464-1460
(405) 550-9210
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
0681R
OK
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
10/17/2022
Last updated
04/11/2026
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