Individual
GARRETT KIZZIA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
ATC
Contact information
Practice address
700 COLLEGE RD, WARNER, OK 74469-2204
(918) 463-6261
Mailing address
PO BOX 25, BRAGGS, OK 74423
(580) 235-6364
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
866
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
866
MEDICAL LICENSE NUMBER
OK
Enumeration date
10/14/2019
Last updated
10/14/2019
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