Provider Demographics
NPI:1649569013
Name:BEATTY, DASHA A
Entity Type:Individual
Prefix:
First Name:DASHA
Middle Name:A
Last Name:BEATTY
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 1:2123 NW 113TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73120-7617
Mailing Address - Country:US
Mailing Address - Phone:405-213-4117
Mailing Address - Fax:
Practice Address - Street 1:11032 QUAIL CREEK RD
Practice Address - Street 2:SUITE 175
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120-6219
Practice Address - Country:US
Practice Address - Phone:405-607-0317
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-06
Last Update Date:2011-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management