Provider Demographics
NPI:1740723865
Name:GARCIA, YANETH (CM)
Entity type:Individual
Prefix:
First Name:YANETH
Middle Name:
Last Name:GARCIA
Suffix:
Gender:F
Credentials:CM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 N. FAIRLAND ST.
Mailing Address - Street 2:
Mailing Address - City:PRYOR
Mailing Address - State:OK
Mailing Address - Zip Code:74361-4203
Mailing Address - Country:US
Mailing Address - Phone:918-915-1561
Mailing Address - Fax:
Practice Address - Street 1:109 N. FAIRLAND ST.
Practice Address - Street 2:
Practice Address - City:PRYOR
Practice Address - State:OK
Practice Address - Zip Code:74361-4203
Practice Address - Country:US
Practice Address - Phone:918-915-1561
Practice Address - Fax:918-825-1406
Is Sole Proprietor?:No
Enumeration Date:2016-11-21
Last Update Date:2018-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200323940Medicaid