Provider Demographics
NPI:1194216390
Name:GARRISON, VICKIE ANGIELETT
Entity Type:Individual
Prefix:
First Name:VICKIE
Middle Name:ANGIELETT
Last Name:GARRISON
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 1:5722 NW 16TH ST APT 6
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73127-6943
Mailing Address - Country:US
Mailing Address - Phone:405-445-8746
Mailing Address - Fax:
Practice Address - Street 1:5722 NW 16TH ST APT 6
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73127-6943
Practice Address - Country:US
Practice Address - Phone:405-445-8746
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-23
Last Update Date:2018-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist