Provider Demographics
NPI:1982322764
Name:MOWREY, DELISA
Entity Type:Individual
Prefix:
First Name:DELISA
Middle Name:
Last Name:MOWREY
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 1:304 N MICKEY MANTLE BLVD
Mailing Address - Street 2:
Mailing Address - City:COMMERCE
Mailing Address - State:OK
Mailing Address - Zip Code:74339-1110
Mailing Address - Country:US
Mailing Address - Phone:918-675-4100
Mailing Address - Fax:
Practice Address - Street 1:130 W STEVE OWENS BLVD
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:OK
Practice Address - Zip Code:74354-7629
Practice Address - Country:US
Practice Address - Phone:918-542-2845
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-18
Last Update Date:2022-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator