Healthcare Provider Details

I. General information

NPI: 1891446092
Provider Name (Legal Business Name): FONTELLA PHILLIPS-REID HOMEHEALTH, CNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/10/2022
Last Update Date: 01/10/2022
Certification Date: 01/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4770 WOODVIEW DR
DEL CITY OK
73115-4224
US

IV. Provider business mailing address

4770 WOODVIEW DR
DEL CITY OK
73115-4224
US

V. Phone/Fax

Practice location:
  • Phone: 405-777-0778
  • Fax:
Mailing address:
  • Phone: 405-777-0778
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number37V618580815
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: