Provider Demographics
NPI:1629189931
Name:KUYKENDALL, R. GREG
Entity type:Individual
Prefix:
First Name:R.
Middle Name:GREG
Last Name:KUYKENDALL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3201 N VAN BUREN ST STE 200
Mailing Address - Street 2:
Mailing Address - City:ENID
Mailing Address - State:OK
Mailing Address - Zip Code:73703-1800
Mailing Address - Country:US
Mailing Address - Phone:580-234-6168
Mailing Address - Fax:580-233-4130
Practice Address - Street 1:3201 N VAN BUREN ST STE 200
Practice Address - Street 2:
Practice Address - City:ENID
Practice Address - State:OK
Practice Address - Zip Code:73703-1800
Practice Address - Country:US
Practice Address - Phone:580-234-6168
Practice Address - Fax:580-233-4130
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2008-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK451237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist