Healthcare Provider Details

I. General information

NPI: 1902408438
Provider Name (Legal Business Name): DR. TIFFANY KRISTEN HOBBS I
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/10/2020
Last Update Date: 11/10/2020
Certification Date: 11/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

605 E MAIN ST
HENRYETTA OK
74437-4439
US

IV. Provider business mailing address

605 E MAIN ST
HENRYETTA OK
74437-4439
US

V. Phone/Fax

Practice location:
  • Phone: 918-652-9447
  • Fax: 918-652-8802
Mailing address:
  • Phone: 918-652-9447
  • Fax: 918-652-8802

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number14332
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: