Healthcare Provider Details

I. General information

NPI: 1801283379
Provider Name (Legal Business Name): TAYLOR HOPCRAFT M.S., A.T.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/22/2015
Last Update Date: 04/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 E B ST
JENKS OK
74037-3906
US

IV. Provider business mailing address

205 E B ST
JENKS OK
74037-3906
US

V. Phone/Fax

Practice location:
  • Phone: 918-299-4415
  • Fax:
Mailing address:
  • Phone: 918-299-4415
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246Z00000X
TaxonomyOther Specialist/Technologist
License Number627
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: