Provider Demographics
NPI:1780202416
Name:WHITEHEAD, CHARITY ELAINE
Entity Type:Individual
Prefix:
First Name:CHARITY
Middle Name:ELAINE
Last Name:WHITEHEAD
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 1:7127 N COUNTY LINE RD
Mailing Address - Street 2:
Mailing Address - City:PIEDMONT
Mailing Address - State:OK
Mailing Address - Zip Code:73078-9136
Mailing Address - Country:US
Mailing Address - Phone:405-858-1752
Mailing Address - Fax:
Practice Address - Street 1:7127 N COUNTY LINE RD
Practice Address - Street 2:
Practice Address - City:PIEDMONT
Practice Address - State:OK
Practice Address - Zip Code:73078-9136
Practice Address - Country:US
Practice Address - Phone:405-858-1752
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-09
Last Update Date:2020-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist