Healthcare Provider Details

I. General information

NPI: 1003282401
Provider Name (Legal Business Name): ANGEL NOVOTNY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MS. ANGEL D. NOVOTNY

II. Dates (important events)

Enumeration Date: 08/19/2015
Last Update Date: 08/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

127 N 3RD AVE
DURANT OK
74701-4700
US

IV. Provider business mailing address

2600 W BROADWAY AVE SUITE 2
SULPHUR OK
73086-6509
US

V. Phone/Fax

Practice location:
  • Phone: 580-745-9535
  • Fax: 580-745-9891
Mailing address:
  • Phone: 580-622-2783
  • Fax: 580-622-5038

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: