Healthcare Provider Details

I. General information

NPI: 1346588746
Provider Name (Legal Business Name): BIBI ANN MABRY MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/21/2013
Last Update Date: 08/16/2022
Certification Date: 08/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

198 E ALMAR DR
CHICKASHA OK
73018-7327
US

IV. Provider business mailing address

146 SKYLINE DR
CHICKASHA OK
73018-7247
US

V. Phone/Fax

Practice location:
  • Phone: 405-222-5437
  • Fax: 405-222-5452
Mailing address:
  • Phone: 405-574-5592
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: