Provider Demographics
NPI:1033655063
Name:DAVIES, CALLIE
Entity Type:Individual
Prefix:
First Name:CALLIE
Middle Name:
Last Name:DAVIES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4009 S URBANA AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74135-2523
Mailing Address - Country:US
Mailing Address - Phone:405-202-7371
Mailing Address - Fax:
Practice Address - Street 1:4009 S URBANA AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-2523
Practice Address - Country:US
Practice Address - Phone:405-202-7371
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-14
Last Update Date:2017-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator