Provider Demographics
NPI:1548422637
Name:NELSON, PATRICIA
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:NELSON
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 501
Mailing Address - Street 2:
Mailing Address - City:BOKOSHE
Mailing Address - State:OK
Mailing Address - Zip Code:74930-0501
Mailing Address - Country:US
Mailing Address - Phone:918-839-2819
Mailing Address - Fax:
Practice Address - Street 1:22626 OLD MAIN
Practice Address - Street 2:
Practice Address - City:BOKOSHE
Practice Address - State:OK
Practice Address - Zip Code:74930
Practice Address - Country:US
Practice Address - Phone:918-839-2819
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-30
Last Update Date:2009-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator