Healthcare Provider Details

I. General information

NPI: 1538628151
Provider Name (Legal Business Name): DONNA LAVON DRINNON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/13/2019
Last Update Date: 03/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3080 W 3RD ST
ELK CITY OK
73644-4323
US

IV. Provider business mailing address

2305 E 7TH ST
ELK CITY OK
73644-8002
US

V. Phone/Fax

Practice location:
  • Phone: 580-225-5136
  • Fax: 580-225-5138
Mailing address:
  • Phone: 580-225-5136
  • Fax: 580-225-5138

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: