Provider Demographics
NPI:1760815377
Name:MOUSER, KAYLEIGH MICHELLE (DPH)
Entity type:Individual
Prefix:
First Name:KAYLEIGH
Middle Name:MICHELLE
Last Name:MOUSER
Suffix:
Gender:F
Credentials:DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8818 S 70TH EAST AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74133-5059
Mailing Address - Country:US
Mailing Address - Phone:918-691-6975
Mailing Address - Fax:
Practice Address - Street 1:3840 S 103RD EAST AVE
Practice Address - Street 2:#234
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74146-2438
Practice Address - Country:US
Practice Address - Phone:918-660-0576
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-19
Last Update Date:2013-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK15489183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist