Provider Demographics
NPI:1275063497
Name:DOUBLEHEAD, DARYLIN
Entity Type:Individual
Prefix:
First Name:DARYLIN
Middle Name:
Last Name:DOUBLEHEAD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DARYLIN
Other - Middle Name:
Other - Last Name:LACIE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:800 N OKLAHOMA AVE APT 1155
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73104-4406
Mailing Address - Country:US
Mailing Address - Phone:918-696-9583
Mailing Address - Fax:
Practice Address - Street 1:RR 6 BOX 840
Practice Address - Street 2:
Practice Address - City:STILWELL
Practice Address - State:OK
Practice Address - Zip Code:74960-8703
Practice Address - Country:US
Practice Address - Phone:918-696-8800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-20
Last Update Date:2018-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK109794163W00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse