Healthcare Provider Details

I. General information

NPI: 1528538329
Provider Name (Legal Business Name): ANNETTE LEDAWN CHOATE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2018
Last Update Date: 12/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

902 E LINCOLN RD
IDABEL OK
74745-7337
US

IV. Provider business mailing address

PO BOX 1577
DURANT OK
74702-1577
US

V. Phone/Fax

Practice location:
  • Phone: 580-286-2600
  • Fax: 580-286-1087
Mailing address:
  • Phone: 580-916-9140
  • Fax: 580-916-9142

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License Number73767
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: