Provider Demographics
NPI:1134446974
Name:OWINGS, KATIE RAE
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:RAE
Last Name:OWINGS
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 1:1822 NE 10TH ST
Mailing Address - Street 2:
Mailing Address - City:BLANCHARD
Mailing Address - State:OK
Mailing Address - Zip Code:73010-9319
Mailing Address - Country:US
Mailing Address - Phone:405-226-8957
Mailing Address - Fax:
Practice Address - Street 1:1822 NE 10TH ST
Practice Address - Street 2:
Practice Address - City:BLANCHARD
Practice Address - State:OK
Practice Address - Zip Code:73010-9319
Practice Address - Country:US
Practice Address - Phone:405-226-8957
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-03
Last Update Date:2013-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK1134446974Medicaid