Provider Demographics
NPI:1114182342
Name:SKINNER, TENIA LADONNA (DO)
Entity Type:Individual
Prefix:DR
First Name:TENIA
Middle Name:LADONNA
Last Name:SKINNER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:129 N 3RD AVE STE C
Mailing Address - Street 2:
Mailing Address - City:PURCELL
Mailing Address - State:OK
Mailing Address - Zip Code:73080-4246
Mailing Address - Country:US
Mailing Address - Phone:405-641-6628
Mailing Address - Fax:405-527-6569
Practice Address - Street 1:129 N 3RD AVE STE C
Practice Address - Street 2:
Practice Address - City:PURCELL
Practice Address - State:OK
Practice Address - Zip Code:73080
Practice Address - Country:US
Practice Address - Phone:405-641-6628
Practice Address - Fax:405-527-6569
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-28
Last Update Date:2018-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3884207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200204740AMedicaid
OKOK404742Medicare UPIN