Provider Demographics
NPI:1053172163
Name:MATHERLY, KAYLA NICOLE (RDMS AB, OB/GYN)
Entity type:Individual
Prefix:
First Name:KAYLA
Middle Name:NICOLE
Last Name:MATHERLY
Suffix:
Gender:F
Credentials:RDMS AB, OB/GYN
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Mailing Address - Street 1:873 S MUSTANG RD
Mailing Address - Street 2:
Mailing Address - City:YUKON
Mailing Address - State:OK
Mailing Address - Zip Code:73099-6779
Mailing Address - Country:US
Mailing Address - Phone:405-990-0631
Mailing Address - Fax:405-251-8692
Practice Address - Street 1:873 S MUSTANG RD
Practice Address - Street 2:
Practice Address - City:YUKON
Practice Address - State:OK
Practice Address - Zip Code:73099-6779
Practice Address - Country:US
Practice Address - Phone:405-990-0631
Practice Address - Fax:405-251-8692
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-17
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK2375702085U0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Ultrasound