Provider Demographics
NPI:1073823431
Name:ATKINSON, MELBA JO
Entity Type:Individual
Prefix:MRS
First Name:MELBA
Middle Name:JO
Last Name:ATKINSON
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 1:4777 110TH. ST.
Mailing Address - Street 2:
Mailing Address - City:BYARS
Mailing Address - State:OK
Mailing Address - Zip Code:74831
Mailing Address - Country:US
Mailing Address - Phone:405-783-4256
Mailing Address - Fax:
Practice Address - Street 1:4777 110TH. ST.
Practice Address - Street 2:
Practice Address - City:BYARS
Practice Address - State:OK
Practice Address - Zip Code:74831
Practice Address - Country:US
Practice Address - Phone:405-783-4256
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-19
Last Update Date:2010-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253J00000XAgenciesFoster Care Agency