Provider Demographics
NPI:1013967694
Name:BINDER KUYKENDALL, LAUREN (PA-C)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:BINDER KUYKENDALL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4200 CARRIAGE WAY
Mailing Address - Street 2:
Mailing Address - City:WEATHERFORD
Mailing Address - State:OK
Mailing Address - Zip Code:73096-9614
Mailing Address - Country:US
Mailing Address - Phone:580-774-2214
Mailing Address - Fax:
Practice Address - Street 1:523 E FRANKLIN AVE
Practice Address - Street 2:
Practice Address - City:WEATHERFORD
Practice Address - State:OK
Practice Address - Zip Code:73096-5337
Practice Address - Country:US
Practice Address - Phone:580-774-7902
Practice Address - Fax:580-774-7912
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2020-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK817363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100102470CMedicaid
OKS49047Medicare UPIN
OK341430934Medicare ID - Type Unspecified