Provider Demographics
NPI:1689457871
Name:FEB-WINTERS, ALISSA JADE LYNN (BS)
Entity Type:Individual
Prefix:MRS
First Name:ALISSA
Middle Name:JADE LYNN
Last Name:FEB-WINTERS
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:ALISSA
Other - Middle Name:JADE LYNN
Other - Last Name:FEB
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:52 BLISS WAY
Mailing Address - Street 2:
Mailing Address - City:MEAD
Mailing Address - State:OK
Mailing Address - Zip Code:73449-7700
Mailing Address - Country:US
Mailing Address - Phone:580-513-1731
Mailing Address - Fax:
Practice Address - Street 1:618 BRYAN DR
Practice Address - Street 2:
Practice Address - City:DURANT
Practice Address - State:OK
Practice Address - Zip Code:74701-3462
Practice Address - Country:US
Practice Address - Phone:580-920-0909
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-14
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator