Healthcare Provider Details

I. General information

NPI: 1508620972
Provider Name (Legal Business Name): ANGELA DAWN TICKLE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ANGELA DAWN TICKLE

II. Dates (important events)

Enumeration Date: 02/07/2024
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4320 VFW DR APT 36
DEL CITY OK
73115-2143
US

IV. Provider business mailing address

4320 VFW DR APT 36
DEL CITY OK
73115-2143
US

V. Phone/Fax

Practice location:
  • Phone: 405-937-6435
  • Fax:
Mailing address:
  • Phone: 405-435-6393
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: