Provider Demographics
NPI:1174276547
Name:MEZZELL-HENDERSON, DAINTA
Entity Type:Individual
Prefix:
First Name:DAINTA
Middle Name:
Last Name:MEZZELL-HENDERSON
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 1:647 CHIPPINGHAM LN
Mailing Address - Street 2:
Mailing Address - City:BLANCHARD
Mailing Address - State:OK
Mailing Address - Zip Code:73010-4052
Mailing Address - Country:US
Mailing Address - Phone:405-268-7226
Mailing Address - Fax:
Practice Address - Street 1:647 CHIPPINGHAM LN
Practice Address - Street 2:
Practice Address - City:BLANCHARD
Practice Address - State:OK
Practice Address - Zip Code:73010-4052
Practice Address - Country:US
Practice Address - Phone:405-268-7226
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-27
Last Update Date:2022-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator