Healthcare Provider Details

I. General information

NPI: 1851533939
Provider Name (Legal Business Name): KATHERINE ALLENE SAMPSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2009
Last Update Date: 04/03/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

430 N MONTE VISTA ST
ADA OK
74820-4610
US

IV. Provider business mailing address

430 N MONTE VISTA ST
ADA OK
74820-4610
US

V. Phone/Fax

Practice location:
  • Phone: 580-332-2323
  • Fax: 580-421-6042
Mailing address:
  • Phone: 580-332-2323
  • Fax: 580-421-6042

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number106-22772
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: