Provider Demographics
NPI:1568832970
Name:HEDGECOCK, KATY DAYNE
Entity Type:Individual
Prefix:
First Name:KATY
Middle Name:DAYNE
Last Name:HEDGECOCK
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 1:662 E COURT ST
Mailing Address - Street 2:
Mailing Address - City:ATOKA
Mailing Address - State:OK
Mailing Address - Zip Code:74525-3016
Mailing Address - Country:US
Mailing Address - Phone:580-364-0606
Mailing Address - Fax:580-364-0866
Practice Address - Street 1:662 E COURT ST
Practice Address - Street 2:
Practice Address - City:ATOKA
Practice Address - State:OK
Practice Address - Zip Code:74525-3016
Practice Address - Country:US
Practice Address - Phone:580-364-0606
Practice Address - Fax:580-364-0866
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-28
Last Update Date:2021-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator