Provider Demographics
NPI:1053678433
Name:COLBERT, NATHEN JOSEPH
Entity Type:Individual
Prefix:
First Name:NATHEN
Middle Name:JOSEPH
Last Name:COLBERT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 NOBLE ST
Mailing Address - Street 2:
Mailing Address - City:POTEAU
Mailing Address - State:OK
Mailing Address - Zip Code:74953-3032
Mailing Address - Country:US
Mailing Address - Phone:918-721-4460
Mailing Address - Fax:
Practice Address - Street 1:210 OAK ST
Practice Address - Street 2:PMB#321
Practice Address - City:POTEAU
Practice Address - State:OK
Practice Address - Zip Code:74953-2339
Practice Address - Country:US
Practice Address - Phone:918-647-2175
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-23
Last Update Date:2012-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator