Provider Demographics
NPI:1538327341
Name:WEATHERS, MINDY
Entity Type:Individual
Prefix:
First Name:MINDY
Middle Name:
Last Name:WEATHERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MINDY
Other - Middle Name:
Other - Last Name:EATON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1011
Mailing Address - Street 2:
Mailing Address - City:CLAREMORE
Mailing Address - State:OK
Mailing Address - Zip Code:74018-1011
Mailing Address - Country:US
Mailing Address - Phone:918-343-1500
Mailing Address - Fax:918-343-1501
Practice Address - Street 1:922 N LYNN RIGGS BLVD
Practice Address - Street 2:
Practice Address - City:CLAREMORE
Practice Address - State:OK
Practice Address - Zip Code:74017-4021
Practice Address - Country:US
Practice Address - Phone:918-343-1500
Practice Address - Fax:918-343-1501
Is Sole Proprietor?:No
Enumeration Date:2008-05-29
Last Update Date:2008-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist