Kendall Wayne Southern, D.O., D.PH.

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

2333 Issued in OK

Practice address

24800 S 4420 Rd
Vinita, OK 74301

Phone

(918) 256-7841

Fax

(918) 256-2952

NPI assigned

Dec 12, 2006

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 7

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Osteopathy, Doctor of Medicine

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Oklahoma Forensic Center

  • Psychiatric Hospital
  • Vinita, OK
  • NPI 1437364080
  NPD (past)
• The Renaissance Centre, Inc.

  • Psychologist
  • Albany, GA
  • NPI 1104970193
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1165881600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1318809600000",
    "number": "1407917792",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 69",
            "city": "VINITA",
            "state": "OK",
            "postal_code": "743010069",
            "telephone_number": "918-261-3612",
            "fax_number": "918-256-2952"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "24800 S 4420 RD",
            "city": "VINITA",
            "state": "OK",
            "postal_code": "74301",
            "telephone_number": "918-256-7841",
            "fax_number": "918-256-2952"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SOUTHERN",
        "first_name": "KENDALL",
        "middle_name": "WAYNE",
        "name_prefix": "Dr.",
        "credential": "D.O., D.PH.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-12-12",
        "last_updated": "2011-10-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "OK",
            "license": "9440",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OK",
            "license": "2333",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "OK",
            "license": "2333",
            "primary": true
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "TX",
            "license": "H9426",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "AL",
            "license": "DO-641",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "GA",
            "license": "48464",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "MI",
            "license": "5101009836",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100124360A",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Zoey Madison Smiles
• Brenda Smith
• Richard James Smith
• Agnes Jean Soler
• Courtney Alexis Soto, DDS
• Spring Dental Vinita, PLLC
• State of Oklahoma
• Stephen P. Mayer, D.D.S., Inc.
• Janey Renee Stevens
• Randi Stewart

• Psychiatry Physician in Vinita, OK
• Providers in Vinita, OK by specialty
• Psychiatry Physician in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.