Provider Demographics
NPI:1174719389
Name:LIPKE, KYLE N (PA)
Entity type:Individual
Prefix:MR
First Name:KYLE
Middle Name:N
Last Name:LIPKE
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 S GRAND
Mailing Address - Street 2:
Mailing Address - City:CRESCENT
Mailing Address - State:OK
Mailing Address - Zip Code:73028-9118
Mailing Address - Country:US
Mailing Address - Phone:405-969-2818
Mailing Address - Fax:405-696-2821
Practice Address - Street 1:400 S GRAND
Practice Address - Street 2:
Practice Address - City:CRESCENT
Practice Address - State:OK
Practice Address - Zip Code:73028-9118
Practice Address - Country:US
Practice Address - Phone:405-969-2818
Practice Address - Fax:405-969-2821
Is Sole Proprietor?:No
Enumeration Date:2007-09-20
Last Update Date:2016-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1667363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant