Provider Demographics
NPI:1184122582
Name:LANKFORD, BRIAN KEITH (MS, ATC, LAT)
Entity type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:KEITH
Last Name:LANKFORD
Suffix:
Gender:M
Credentials:MS, ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 430
Mailing Address - Street 2:
Mailing Address - City:GOODWELL
Mailing Address - State:OK
Mailing Address - Zip Code:73939-0430
Mailing Address - Country:US
Mailing Address - Phone:580-349-1338
Mailing Address - Fax:580-349-1419
Practice Address - Street 1:323 W EAGLE BLVD
Practice Address - Street 2:
Practice Address - City:GOODWELL
Practice Address - State:OK
Practice Address - Zip Code:73939-1500
Practice Address - Country:US
Practice Address - Phone:580-349-1338
Practice Address - Fax:580-349-1419
Is Sole Proprietor?:No
Enumeration Date:2018-01-31
Last Update Date:2018-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2682255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer