Healthcare Provider Details

I. General information

NPI: 1326707324
Provider Name (Legal Business Name): TINA HULL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/17/2021
Last Update Date: 12/17/2021
Certification Date: 12/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 N NEWELL ST
COALGATE OK
74538-2427
US

IV. Provider business mailing address

303 N NEWELL ST
COALGATE OK
74538-2427
US

V. Phone/Fax

Practice location:
  • Phone: 580-297-2372
  • Fax:
Mailing address:
  • Phone: 580-297-2372
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License NumberA088104727
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: