Basic Information
| Provider Information | |||||||||
| NPI: | 1154948040 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MYERS | ||||||||
| FirstName: | KILEY | ||||||||
| MiddleName: | |||||||||
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| Credential: | MSW, LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 21 RESERVOIR RD | ||||||||
| Address2: | |||||||||
| City: | BUFFALO | ||||||||
| State: | WY | ||||||||
| PostalCode: | 828349385 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3072172413 | ||||||||
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| Practice Location | |||||||||
| Address1: | 5310 E 31ST ST | ||||||||
| Address2: | |||||||||
| City: | TULSA | ||||||||
| State: | OK | ||||||||
| PostalCode: | 741355018 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9186003100 | ||||||||
| FaxNumber: | 9185601399 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/26/2020 | ||||||||
| LastUpdateDate: | 07/14/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/14/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | PCSW-909 | WY | N | Behavioral Health & Social Service Providers | Social Worker | Clinical | 1041C0700X | LCSW-1429 | WY | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.