Provider Demographics
NPI:1669088860
Name:POWELL, ROXIE R
Entity type:Individual
Prefix:
First Name:ROXIE
Middle Name:R
Last Name:POWELL
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 1:1116 N MAIN ST STE M12
Mailing Address - Street 2:
Mailing Address - City:ALTUS
Mailing Address - State:OK
Mailing Address - Zip Code:73521-3149
Mailing Address - Country:US
Mailing Address - Phone:580-379-0677
Mailing Address - Fax:
Practice Address - Street 1:1116 N MAIN ST STE M12
Practice Address - Street 2:
Practice Address - City:ALTUS
Practice Address - State:OK
Practice Address - Zip Code:73521-3149
Practice Address - Country:US
Practice Address - Phone:580-379-0677
Practice Address - Fax:580-482-0008
Is Sole Proprietor?:No
Enumeration Date:2020-09-22
Last Update Date:2021-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program