Healthcare Provider Details

I. General information

NPI: 1669726675
Provider Name (Legal Business Name): CAROL OWENS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/30/2012
Last Update Date: 10/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5912 HIGHWAY 70 EAST
MEAD OK
73449
US

IV. Provider business mailing address

PO BOX 48
MEAD OK
73449-0048
US

V. Phone/Fax

Practice location:
  • Phone: 580-745-9083
  • Fax: 580-745-9885
Mailing address:
  • Phone: 580-745-9610
  • Fax: 580-745-9650

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: