Individual
ALLIE KENNEDY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1919 S WHEELING AVE STE 500, TULSA, OK 74104-5634
(918) 403-6284
Mailing address
9211 E 93RD PL, TULSA, OK 74133-5612
(918) 606-8530
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
4763
OK
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
10/15/2019
Last updated
03/24/2022
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