Provider Demographics
NPI:1649865908
Name:WORTH, DANA KELLY (AUDIOLOGIST)
Entity type:Individual
Prefix:DR
First Name:DANA
Middle Name:KELLY
Last Name:WORTH
Suffix:
Gender:M
Credentials:AUDIOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4564 S HARVARD AVE
Mailing Address - Street 2:STE A
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74135-2918
Mailing Address - Country:US
Mailing Address - Phone:918-743-9052
Mailing Address - Fax:918-749-9770
Practice Address - Street 1:4564 S HARVARD AVE STE A
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-2918
Practice Address - Country:US
Practice Address - Phone:918-743-9052
Practice Address - Fax:918-749-9770
Is Sole Proprietor?:No
Enumeration Date:2021-03-08
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5463231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist