Provider Demographics
NPI:1891436275
Name:CHILES, WINFRED A II
Entity Type:Individual
Prefix:MR
First Name:WINFRED
Middle Name:A
Last Name:CHILES
Suffix:II
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 1:101 CARLYLE DR APT 823
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74012-8017
Mailing Address - Country:US
Mailing Address - Phone:918-606-5575
Mailing Address - Fax:
Practice Address - Street 1:101 CARLYLE DR APT 823
Practice Address - Street 2:
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74012-8017
Practice Address - Country:US
Practice Address - Phone:918-606-5575
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-07
Last Update Date:2022-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK171400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach