1992303721 NPI number — MISTY WATKINS

Table of content: (NPI 1992303721)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992303721 NPI number — MISTY WATKINS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MISTY WATKINS
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1992303721
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/10/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6608 N WESTERN AVE # 1265
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OKLAHOMA CITY
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
73116-7326
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
405-825-1784
Provider Business Mailing Address Fax Number:
580-771-2012

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1010 S 7TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHICKASHA
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73018
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
405-825-1784
Provider Business Practice Location Address Fax Number:
580-771-2012
Provider Enumeration Date:
10/14/2020

Additional Information

Authorized Official

Authorized Official Last Name:
WATKINS
Authorized Official First Name:
MISTY
Authorized Official Middle Name:
Authorized Official Title or Position:
LICENSED PROFESSIONAL COUNSELOR
Authorized Official Telephone Number:
580-284-8729

Provider Taxonomy Codes

  • Taxonomy code: 261QM0801X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 200709510A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".




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