Healthcare Provider Details

I. General information

NPI: 1588999155
Provider Name (Legal Business Name): FAYE ANTIONETTE POWELL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/14/2009
Last Update Date: 10/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

423 W WILL ROGERS BLVD
CLAREMORE OK
74017-6820
US

IV. Provider business mailing address

8023 S WHEELING AVE APT D
TULSA OK
74136-5233
US

V. Phone/Fax

Practice location:
  • Phone: 918-342-2080
  • Fax: 918-342-0075
Mailing address:
  • Phone: 912-604-1770
  • 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: