Dr Kendall Wayne Southern, DO, DPH is a
Psychiatry & Neurology - Psychiatry based in Vinita, Oklahoma. Dr Kendall Wayne Southern is licensed to practice in Oklahoma (license number 2333) and his current practice location is
24800 S 4420 Rd, Vinita, Oklahoma. He can be reached at his office (for appointments etc.) via phone at
(918) 256-7841.
NPI number for Dr Kendall Wayne Southern is 1407917792 and his current mailing address is Po Box 69, Vinita, Oklahoma. He
does not participate in medicare program and thus does not accept medicare assignments. His NPI Number is 1407917792.
Healthcare Provider's Profile
| Full Name | Dr Kendall Wayne Southern |
|---|
| Gender | Male |
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| Speciality | Psychiatry & Neurology - Psychiatry |
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| Location | 24800 S 4420 Rd, Vinita, Oklahoma |
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| Accepts Medicare Assignments | Does not participate in Medicare Program. He may not accept medicare assignment. |
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NPI Data:
- NPI Number: 1407917792
- Provider Enumeration Date: 12/12/2006
- Last Update Date: 10/17/2011
Medical Identifiers
Medical identifiers for Dr Kendall Wayne Southern such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1407917792 | NPI | - | NPPES |
| 100124360A | Medicaid | OK | |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 183500000X | Pharmacist | 9440 (Oklahoma) | Secondary |
| 207Q00000X | Family Medicine | 2333 (Oklahoma) | Secondary |
| 2084P0800X | Psychiatry & Neurology - Psychiatry | 2333 (Oklahoma) | Primary |
| 2084P0800X | Psychiatry & Neurology - Psychiatry | H9426 (Texas) | Secondary |
| 2084P0800X | Psychiatry & Neurology - Psychiatry | DO-641 (Alabama) | Secondary |
| 2084P0800X | Psychiatry & Neurology - Psychiatry | 48464 (Georgia) | Secondary |
| 2084P0800X | Psychiatry & Neurology - Psychiatry | 5101009836 (Michigan) | Secondary |
Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Dr Kendall Wayne Southern is
NOT enrolled with medicare and thus cannot prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
|---|
Dr Kendall Wayne Southern, DO, DPH
Po Box 69,
Vinita, OK 74301-0069
Ph: (918) 261-3612 | Dr Kendall Wayne Southern, DO, DPH
24800 S 4420 Rd,
Vinita, OK 74301
Ph: (918) 256-7841 |
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