Healthcare Provider Details

I. General information

NPI: 1295085033
Provider Name (Legal Business Name): MINDY FANCHER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/19/2012
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

324 N WASHINGTON AVE
DURANT OK
74701-3642
US

IV. Provider business mailing address

3077 E 2100 RD
HUGO OK
74743-4527
US

V. Phone/Fax

Practice location:
  • Phone: 580-931-3008
  • Fax:
Mailing address:
  • Phone: 580-743-6146
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number9202
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: