Provider Demographics
NPI:1235721671
Name:DAN, KATHY
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:
Last Name:DAN
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:PO BOX 534
Mailing Address - Street 2:
Mailing Address - City:CHECOTAH
Mailing Address - State:OK
Mailing Address - Zip Code:74426-0534
Mailing Address - Country:US
Mailing Address - Phone:405-633-8557
Mailing Address - Fax:
Practice Address - Street 1:225 VITEO GUEST AVE
Practice Address - Street 2:
Practice Address - City:CHECOTAH
Practice Address - State:OK
Practice Address - Zip Code:74426-2612
Practice Address - Country:US
Practice Address - Phone:918-329-9140
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-08
Last Update Date:2021-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider