Healthcare Provider Details

I. General information

NPI: 1033544903
Provider Name (Legal Business Name): PATRICIA DENISE RUPE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2013
Last Update Date: 09/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

619 N MAIN ST
MUSKOGEE OK
74401-4431
US

IV. Provider business mailing address

619 N MAIN ST
MUSKOGEE OK
74401-4431
US

V. Phone/Fax

Practice location:
  • Phone: 918-913-3655
  • Fax: 918-687-0976
Mailing address:
  • Phone: 918-913-3655
  • Fax: 918-687-0976

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: