Provider Demographics
NPI:1831753698
Name:BYRD, RHONDA GAIL
Entity type:Individual
Prefix:
First Name:RHONDA
Middle Name:GAIL
Last Name:BYRD
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 1:302 W QUANTICO ST
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74011-2209
Mailing Address - Country:US
Mailing Address - Phone:918-577-8420
Mailing Address - Fax:
Practice Address - Street 1:302 W QUANTICO ST
Practice Address - Street 2:
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74011-2209
Practice Address - Country:US
Practice Address - Phone:918-577-8420
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-26
Last Update Date:2019-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator