Individual
KENNEDI ELIZABETH PUCKETT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
1110 N LEE AVE STE 300, OKLAHOMA CITY, OK 73103-2612
(405) 231-3000
Mailing address
9000 NW 144TH ST, YUKON, OK 73099-4731
(918) 869-2515
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
OK
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/04/2023
Last updated
07/30/2024
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