Healthcare Provider Details

I. General information

NPI: 1699984369
Provider Name (Legal Business Name): DANA KIRKPATRICK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/21/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

604 CHOCTAW ST
ALVA OK
73717-1626
US

IV. Provider business mailing address

1222 10TH ST STE 211
WOODWARD OK
73801-3156
US

V. Phone/Fax

Practice location:
  • Phone: 580-327-1112
  • Fax: 580-327-3067
Mailing address:
  • Phone: 580-327-1112
  • Fax: 580-327-3067

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number62402
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: