Provider Demographics
NPI:1821524893
Name:HEAD, RANCE
Entity Type:Individual
Prefix:
First Name:RANCE
Middle Name:
Last Name:HEAD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31179 S MOLLY BROWN MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:COOKSON
Mailing Address - State:OK
Mailing Address - Zip Code:74427-2523
Mailing Address - Country:US
Mailing Address - Phone:417-622-2821
Mailing Address - Fax:
Practice Address - Street 1:31179 S MOLLY BROWN MOUNTAIN RD
Practice Address - Street 2:
Practice Address - City:COOKSON
Practice Address - State:OK
Practice Address - Zip Code:74427-2523
Practice Address - Country:US
Practice Address - Phone:417-622-2821
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-11
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator