Provider Demographics
NPI:1376185330
Name:MARTIN, NATISHA LYNN
Entity Type:Individual
Prefix:
First Name:NATISHA
Middle Name:LYNN
Last Name:MARTIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:NATISHA
Other - Middle Name:LYNN
Other - Last Name:HINKLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PARAPROFESSIONAL
Mailing Address - Street 1:STILWELL PUBLIC SCHOOL
Mailing Address - Street 2:520 W. DIVISON ST.
Mailing Address - City:STILWELL
Mailing Address - State:OK
Mailing Address - Zip Code:74960
Mailing Address - Country:US
Mailing Address - Phone:918-696-7001
Mailing Address - Fax:918-696-6824
Practice Address - Street 1:STILWELL PUBLIC SCHOOL
Practice Address - Street 2:520 W. DIVISON ST.
Practice Address - City:STILWELL
Practice Address - State:OK
Practice Address - Zip Code:74960
Practice Address - Country:US
Practice Address - Phone:918-696-7001
Practice Address - Fax:918-696-6824
Is Sole Proprietor?:No
Enumeration Date:2019-10-11
Last Update Date:2019-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant