Provider Demographics
NPI:1275887960
Name:RANDALL, DIXI DENISE (BA)
Entity Type:Individual
Prefix:
First Name:DIXI
Middle Name:DENISE
Last Name:RANDALL
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1017 NW 6TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73106-7202
Mailing Address - Country:US
Mailing Address - Phone:405-605-8282
Mailing Address - Fax:
Practice Address - Street 1:1017 NW 6TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73106-7202
Practice Address - Country:US
Practice Address - Phone:405-605-8282
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-01
Last Update Date:2012-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health