Provider Demographics
NPI:1942702220
Name:AZLIN, KATHRYN NICOLE
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:NICOLE
Last Name:AZLIN
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 1:1121 S OKFUSKEE AVE
Mailing Address - Street 2:
Mailing Address - City:WEWOKA
Mailing Address - State:OK
Mailing Address - Zip Code:74884-3553
Mailing Address - Country:US
Mailing Address - Phone:405-683-0254
Mailing Address - Fax:405-257-2149
Practice Address - Street 1:12530 NS 3660
Practice Address - Street 2:
Practice Address - City:WEWOKA
Practice Address - State:OK
Practice Address - Zip Code:74884-6021
Practice Address - Country:US
Practice Address - Phone:405-683-0254
Practice Address - Fax:405-257-5473
Is Sole Proprietor?:No
Enumeration Date:2018-03-02
Last Update Date:2018-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator