Provider Demographics
NPI:1619248291
Name:REUTER, MISTY DEHEON (AA)
Entity Type:Individual
Prefix:
First Name:MISTY
Middle Name:DEHEON
Last Name:REUTER
Suffix:
Gender:F
Credentials:AA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:409 E COMMERCE ST
Mailing Address - Street 2:
Mailing Address - City:ALTUS
Mailing Address - State:OK
Mailing Address - Zip Code:73521-3917
Mailing Address - Country:US
Mailing Address - Phone:580-471-8602
Mailing Address - Fax:
Practice Address - Street 1:409 E COMMERCE ST
Practice Address - Street 2:
Practice Address - City:ALTUS
Practice Address - State:OK
Practice Address - Zip Code:73521-3917
Practice Address - Country:US
Practice Address - Phone:580-471-8602
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-13
Last Update Date:2012-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator