Wallace, Kacey L

Wallace, Kacey L is an individual health care provider with primary practice located at 1000 W Choctaw Ave Ste 9 , Chickasha OK 73018. She recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as her primary health care specialty. Wallace, Kacey L can be contacted via phone (405) 544-2940.

Contact Information

Primary practice address
1000 W Choctaw Ave Ste 9 Chickasha OK 73018
Phone: (405) 544-2940
Fax: (405) 337-9632
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X 4339 Oklahoma

Profile Details

NPI number 1306868534
LBN Legal business name Wallace, Kacey L
Credentials Doctor of Osteopathy (DO)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 24th, 2006
Last updated Nov 24th, 2023 - about 3 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 1306868534 NPPES
Oklahoma Other P00331218 MEDICARE RAIL ROAD
Oklahoma MEDICAID 200077860A MEDICARE RAIL ROAD

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