Provider Demographics
NPI:1295391373
Name:MOWDY, KATY LYNN
Entity Type:Individual
Prefix:
First Name:KATY
Middle Name:LYNN
Last Name:MOWDY
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 1:11530 OK HIGHWAY 78 S
Mailing Address - Street 2:
Mailing Address - City:MILBURN
Mailing Address - State:OK
Mailing Address - Zip Code:73450-0045
Mailing Address - Country:US
Mailing Address - Phone:405-892-9096
Mailing Address - Fax:
Practice Address - Street 1:11530 OK HIGHWAY 78 S
Practice Address - Street 2:
Practice Address - City:MILBURN
Practice Address - State:OK
Practice Address - Zip Code:73450-0045
Practice Address - Country:US
Practice Address - Phone:405-892-9096
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-14
Last Update Date:2019-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty