Provider Demographics
NPI:1063003705
Name:HAMMONDS, KATIE LORAINE
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:LORAINE
Last Name:HAMMONDS
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 1:19454 E 122ND ST S
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74014-4504
Mailing Address - Country:US
Mailing Address - Phone:918-853-2132
Mailing Address - Fax:
Practice Address - Street 1:1010 E WILL ROGERS BLVD
Practice Address - Street 2:
Practice Address - City:CLAREMORE
Practice Address - State:OK
Practice Address - Zip Code:74017-6352
Practice Address - Country:US
Practice Address - Phone:918-342-3334
Practice Address - Fax:918-342-3367
Is Sole Proprietor?:No
Enumeration Date:2021-01-26
Last Update Date:2021-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist