Organization
KENNETH DALE PRIEST MD PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MELENIE NACHIMSON (CREDENTIALING SPECIALIST)
(405) 775-9350
Entity
Organization
Contact information
Practice address
3705 W MEMORIAL RD, SUITE 302, OKLAHOMA CITY, OK 73134-1512
(405) 775-9350
(405) 775-9360
Mailing address
PO BOX 272606, OKLAHOMA CITY, OK 73137-2606
(405) 775-9350
(405) 775-9360
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
19107
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100744690A
—
OK
01
—
358460300
DOL
OK
01
—
4647871
AETNA
OK
01
—
DB6320
MEDICARE RR GROUP
OK
01
—
P00118819
RR/MEDICARE
OK
Enumeration date
09/22/2005
Last updated
06/16/2011
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