Provider Demographics
NPI:1629861166
Name:KIPROTICH, DOUGLASH
Entity type:Individual
Prefix:
First Name:DOUGLASH
Middle Name:
Last Name:KIPROTICH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:DOUGLASH
Other - Middle Name:
Other - Last Name:KIPROTICH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:27 LAKE DR
Mailing Address - Street 2:
Mailing Address - City:ARDMORE
Mailing Address - State:OK
Mailing Address - Zip Code:73401-8422
Mailing Address - Country:US
Mailing Address - Phone:469-728-3580
Mailing Address - Fax:
Practice Address - Street 1:333 W MAIN ST STE 290
Practice Address - Street 2:
Practice Address - City:ARDMORE
Practice Address - State:OK
Practice Address - Zip Code:73401-6330
Practice Address - Country:US
Practice Address - Phone:580-235-1491
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-27
Last Update Date:2025-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator