Provider Demographics
NPI:1518324391
Name:WHITLEY, DOCHELLE ANTOINETTE
Entity Type:Individual
Prefix:
First Name:DOCHELLE
Middle Name:ANTOINETTE
Last Name:WHITLEY
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 1:5309 FOSTER DR
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73135-1425
Mailing Address - Country:US
Mailing Address - Phone:405-474-4949
Mailing Address - Fax:
Practice Address - Street 1:5309 FOSTER DR
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73135-1425
Practice Address - Country:US
Practice Address - Phone:405-474-4949
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-25
Last Update Date:2016-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator