MEDICARE: MARY DINKINS

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	103TF0000X	Family Psychologist

General Provider Information

NPI Number	:	1942614003
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY DINKINS

Provider Business Mailing Address
First Line	:	1229 NE 46TH ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73111-5807
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1229 NE 46TH ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73111-5807
Country	:	US
Telephone Number	:	405-427-9401
Fax Number	:

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

Provider Enumeration Date	:	06/17/2014
Last Update Date	:	06/17/2014

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Directions to “ MARY DINKINS ” Practice Location

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