Provider Demographics
NPI:1225298235
Name:UPCHURCH, ARNEICE (BS, CCM)
Entity Type:Individual
Prefix:MISS
First Name:ARNEICE
Middle Name:
Last Name:UPCHURCH
Suffix:
Gender:F
Credentials:BS, CCM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1607 SW 15TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73108-6803
Mailing Address - Country:US
Mailing Address - Phone:405-634-0508
Mailing Address - Fax:405-616-5678
Practice Address - Street 1:1607 SW 15TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73108-6803
Practice Address - Country:US
Practice Address - Phone:405-634-0508
Practice Address - Fax:405-616-5678
Is Sole Proprietor?:No
Enumeration Date:2008-06-12
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK20646171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100729210Medicaid