Southern, Kendall Wayne

Southern, Kendall Wayne is an sole proprietor health care provider with primary practice located at 24800 S 4420 Rd , Vinita OK 74301. He recently has 3 registered licenses in different health care specialties including Pharmacy Service Providers / Pharmacist, Allopathic & Osteopathic Physicians / Family Medicine, Allopathic & Osteopathic Physicians / Psychiatry. Allopathic & Osteopathic Physicians / Psychiatry is his primary health care specialty. Southern, Kendall Wayne can be contacted via phone (918) 256-7841.

Contact Information

Primary practice address
24800 S 4420 Rd Vinita OK 74301
Phone: (918) 256-7841
Fax: (918) 256-2952
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Pharmacy Service Providers / Pharmacist 183500000X 9440 Oklahoma
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X 2333 Oklahoma
Allopathic & Osteopathic Physicians / Psychiatry 2084P0800X 2333 Oklahoma
Allopathic & Osteopathic Physicians / Psychiatry 2084P0800X H9426 Texas
Allopathic & Osteopathic Physicians / Psychiatry 2084P0800X DO-641 Alabama
Allopathic & Osteopathic Physicians / Psychiatry 2084P0800X 48464 Georgia
Allopathic & Osteopathic Physicians / Psychiatry 2084P0800X 5101009836 Michigan

Profile Details

NPI number 1407917792
LBN Legal business name Southern, Kendall Wayne
Credentials D.O., D.PH.
Entity Individual
Sole proprietor 1 Yes
Enumeration date Dec 12th, 2006
Last updated Oct 17th, 2011 - about 15 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1407917792 NPPES
Oklahoma MEDICAID 100124360A

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