Provider Demographics
NPI:1114373412
Name:JUST, BOBBIE
Entity Type:Individual
Prefix:
First Name:BOBBIE
Middle Name:
Last Name:JUST
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 1:300 RANGER BLVD
Mailing Address - Street 2:
Mailing Address - City:ROLAND
Mailing Address - State:OK
Mailing Address - Zip Code:74954-4040
Mailing Address - Country:US
Mailing Address - Phone:918-427-4601
Mailing Address - Fax:
Practice Address - Street 1:300 RANGER BLVD
Practice Address - Street 2:
Practice Address - City:ROLAND
Practice Address - State:OK
Practice Address - Zip Code:74954-4040
Practice Address - Country:US
Practice Address - Phone:918-427-4601
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-05
Last Update Date:2016-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant