Provider Demographics
NPI:1699007161
Name:MYLES, KATRINA C (CASE MANAGER)
Entity Type:Individual
Prefix:
First Name:KATRINA
Middle Name:C
Last Name:MYLES
Suffix:
Gender:F
Credentials:CASE MANAGER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2518 NE 15TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73117-5225
Mailing Address - Country:US
Mailing Address - Phone:817-995-9921
Mailing Address - Fax:
Practice Address - Street 1:2518 NE 15TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73117-5225
Practice Address - Country:US
Practice Address - Phone:817-995-9921
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-08
Last Update Date:2015-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health