Provider Demographics
NPI:1295476794
Name:WARNER, AKEIRA I
Entity type:Individual
Prefix:
First Name:AKEIRA
Middle Name:
Last Name:WARNER
Suffix:I
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 1:1504 ROYSTER RD
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76134-3604
Mailing Address - Country:US
Mailing Address - Phone:817-919-6059
Mailing Address - Fax:
Practice Address - Street 1:1011 E TAFT AVE
Practice Address - Street 2:
Practice Address - City:SAPULPA
Practice Address - State:OK
Practice Address - Zip Code:74066-5730
Practice Address - Country:US
Practice Address - Phone:918-212-6943
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-06
Last Update Date:2025-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND14864122300000X
TX38614122300000X
390200000X
OK7983122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program