Provider Demographics
NPI:1699825364
Name:KINGFISHER PUBLIC SCHOOL
Entity Type:Organization
Organization Name:KINGFISHER PUBLIC SCHOOL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAID COORDINATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:IRENE
Authorized Official - Middle Name:T
Authorized Official - Last Name:GARRETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-375-4194
Mailing Address - Street 1:1400 S OAK ST
Mailing Address - Street 2:
Mailing Address - City:KINGFISHER
Mailing Address - State:OK
Mailing Address - Zip Code:73750-4314
Mailing Address - Country:US
Mailing Address - Phone:405-375-4194
Mailing Address - Fax:405-375-5565
Practice Address - Street 1:1400 S OAK ST
Practice Address - Street 2:
Practice Address - City:KINGFISHER
Practice Address - State:OK
Practice Address - Zip Code:73750-4314
Practice Address - Country:US
Practice Address - Phone:405-375-4194
Practice Address - Fax:405-375-5565
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100676280AMedicaid