Healthcare Provider Details

I. General information

NPI: 1699567552
Provider Name (Legal Business Name): ALICE MARTINEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2025
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

536 SE GREYSTONE AVE
BARTLESVILLE OK
74006-8420
US

IV. Provider business mailing address

705 S VIRGINIA AVE
BARTLESVILLE OK
74003-4439
US

V. Phone/Fax

Practice location:
  • Phone: 918-332-7449
  • Fax:
Mailing address:
  • Phone: 844-458-2100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: