Provider Demographics
NPI:1639838949
Name:WAIGHT, RUTHY M
Entity Type:Individual
Prefix:
First Name:RUTHY
Middle Name:M
Last Name:WAIGHT
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 1:223 GRAY JAY RD
Mailing Address - Street 2:
Mailing Address - City:VALLIANT
Mailing Address - State:OK
Mailing Address - Zip Code:74764-5231
Mailing Address - Country:US
Mailing Address - Phone:580-212-8865
Mailing Address - Fax:
Practice Address - Street 1:601 E JACKSON ST
Practice Address - Street 2:
Practice Address - City:HUGO
Practice Address - State:OK
Practice Address - Zip Code:74743-4024
Practice Address - Country:US
Practice Address - Phone:580-326-7531
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-14
Last Update Date:2021-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator