Individual
NICOLLETTE KENNEDY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
16414 W 760 RD, TAHLEQUAH, OK 74464-1675
(918) 822-1191
Mailing address
16414 W 760 RD, TAHLEQUAH, OK 74464-1675
(918) 822-1191
Taxonomy
Speciality
Code
Description
License number
State
405300000X
Prevention Professional
Primary
K083179009
OK
Other
Enumeration date
05/28/2024
Last updated
05/28/2024
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