Provider Demographics
NPI:1346013950
Name:HAVENAR, KATIE JOY
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:JOY
Last Name:HAVENAR
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 148
Mailing Address - Street 2:
Mailing Address - City:BARNSDALL
Mailing Address - State:OK
Mailing Address - Zip Code:74002-0148
Mailing Address - Country:US
Mailing Address - Phone:918-332-8051
Mailing Address - Fax:
Practice Address - Street 1:108 W VINE AVE
Practice Address - Street 2:
Practice Address - City:BARNSDALL
Practice Address - State:OK
Practice Address - Zip Code:74002-6641
Practice Address - Country:US
Practice Address - Phone:918-332-8051
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-06
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist