Healthcare Provider Details

I. General information

NPI: 1154355535
Provider Name (Legal Business Name): JOHN FLINT WISE LMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1170 COUNTY ROAD 1389
CHICKASHA OK
73018-4100
US

IV. Provider business mailing address

1170 COUNTY ROAD 1389
CHICKASHA OK
73018-4100
US

V. Phone/Fax

Practice location:
  • Phone: 405-224-5898
  • Fax:
Mailing address:
  • Phone: 405-224-5898
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number3019
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: