Healthcare Provider Details

I. General information

NPI: 1225528409
Provider Name (Legal Business Name): PRISCILLA ANNE CHIQUIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: PRISCILLA ANNE CROWDER

II. Dates (important events)

Enumeration Date: 05/14/2018
Last Update Date: 04/29/2024
Certification Date: 04/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

245 S. MADISON
BARTLESVILLE OK
74006-3847
US

IV. Provider business mailing address

245 S MADISON BLVD
BARTLESVILLE OK
74006-2822
US

V. Phone/Fax

Practice location:
  • Phone: 918-336-1463
  • Fax: 918-331-9717
Mailing address:
  • Phone: 918-851-1528
  • Fax: 918-337-8099

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number8108
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: