Provider Demographics
NPI:1669719035
Name:ONCHWATI, GLADYS
Entity type:Individual
Prefix:
First Name:GLADYS
Middle Name:
Last Name:ONCHWATI
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 S OKLAHOMA AVE
Mailing Address - Street 2:
Mailing Address - City:CHEROKEE
Mailing Address - State:OK
Mailing Address - Zip Code:73728-2545
Mailing Address - Country:US
Mailing Address - Phone:682-203-6848
Mailing Address - Fax:580-596-2805
Practice Address - Street 1:405 S OKLAHOMA AVE
Practice Address - Street 2:
Practice Address - City:CHEROKEE
Practice Address - State:OK
Practice Address - Zip Code:73728-2545
Practice Address - Country:US
Practice Address - Phone:580-596-2800
Practice Address - Fax:580-596-2805
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-05
Last Update Date:2025-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX220188164X00000X
TXAP135264363LP0808X
OKM131619363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No164X00000XNursing Service ProvidersLicensed Vocational Nurse
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health