MEDICARE: KARRI LOCUST

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1326406109
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KARRI LOCUST

Provider Business Mailing Address
First Line	:	113 W SHAWNEE ST
Second Line	:
City	:	TAHLEQUAH
State	:	OK
Zip	:	74464-3623
Country	:	US
Telephone Number	:	918-825-1405
Fax Number	:	918-825-1406

Provider Business Practice Location Address
First Line	:	113 W SHAWNEE ST
Second Line	:
City	:	TAHLEQUAH
State	:	OK
Zip	:	74464-3623
Country	:	US
Telephone Number	:	918-825-1405
Fax Number	:	918-825-1406

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/08/2016
Last Update Date	:	02/10/2016

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Directions to “ KARRI LOCUST ” Practice Location

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