Healthcare Provider Details

I. General information

NPI: 1669735361
Provider Name (Legal Business Name): RAKEIA SIMONE MCNEILL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/19/2012
Last Update Date: 06/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1717 W 33RD ST
EDMOND OK
73013-3863
US

IV. Provider business mailing address

4519 NE 38TH ST
OKLAHOMA CITY OK
73121-6400
US

V. Phone/Fax

Practice location:
  • Phone: 405-216-5608
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: