Provider Demographics
NPI:1275804288
Name:MORRIS, KATHIE M
Entity Type:Individual
Prefix:
First Name:KATHIE
Middle Name:M
Last Name:MORRIS
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:HC 66 BOX 21
Mailing Address - Street 2:
Mailing Address - City:PROCTOR
Mailing Address - State:OK
Mailing Address - Zip Code:74457-9608
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:HC 66 BOX 21
Practice Address - Street 2:
Practice Address - City:PROCTOR
Practice Address - State:OK
Practice Address - Zip Code:74457-9608
Practice Address - Country:US
Practice Address - Phone:918-723-5399
Practice Address - Fax:918-456-0140
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-23
Last Update Date:2012-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor