Provider Demographics
NPI:1851153936
Name:PRITCHETT, LAURA DAWN
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:DAWN
Last Name:PRITCHETT
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:P.O. BOX 410
Mailing Address - Street 2:
Mailing Address - City:WESTVILLE
Mailing Address - State:OK
Mailing Address - Zip Code:74965
Mailing Address - Country:US
Mailing Address - Phone:918-723-3181
Mailing Address - Fax:918-723-4581
Practice Address - Street 1:500 CHINCAPIN HWY 62 W
Practice Address - Street 2:
Practice Address - City:WESTVILLE
Practice Address - State:OK
Practice Address - Zip Code:74965
Practice Address - Country:US
Practice Address - Phone:918-723-3181
Practice Address - Fax:918-723-4581
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-25
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172V00000XOther Service ProvidersCommunity Health WorkerGroup - Single Specialty