Provider Demographics
NPI:1346587078
Name:NEBLETT, AUDREA JUNE
Entity Type:Individual
Prefix:
First Name:AUDREA
Middle Name:JUNE
Last Name:NEBLETT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:AUDREA
Other - Middle Name:JUNE
Other - Last Name:GLOVER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1026 N BYRD ST
Mailing Address - Street 2:
Mailing Address - City:TISHOMINGO
Mailing Address - State:OK
Mailing Address - Zip Code:73460-1504
Mailing Address - Country:US
Mailing Address - Phone:580-371-0031
Mailing Address - Fax:
Practice Address - Street 1:1026 N BYRD ST
Practice Address - Street 2:
Practice Address - City:TISHOMINGO
Practice Address - State:OK
Practice Address - Zip Code:73460-1504
Practice Address - Country:US
Practice Address - Phone:580-371-0031
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-15
Last Update Date:2013-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion