Healthcare Provider Details

I. General information

NPI: 1972841831
Provider Name (Legal Business Name): MRS. VALERIE JO RENA DODSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/27/2013
Last Update Date: 08/21/2024
Certification Date: 08/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

705 W 13TH ST
ATOKA OK
74525-3712
US

IV. Provider business mailing address

36972 COUNTY ROAD 1640
TUPELO OK
74572-6005
US

V. Phone/Fax

Practice location:
  • Phone: 580-889-5555
  • Fax:
Mailing address:
  • Phone: 580-927-0022
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: