Healthcare Provider Details

I. General information

NPI: 1720397938
Provider Name (Legal Business Name): MRS. DEIDRE T. ALEXANDER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2010
Last Update Date: 10/05/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 12TH AVE NE
NORMAN OK
73071-5238
US

IV. Provider business mailing address

3401 W MISSISSIPPI AVE
CHICKASHA OK
73018-6149
US

V. Phone/Fax

Practice location:
  • Phone: 405-573-3819
  • Fax:
Mailing address:
  • Phone: 405-222-4367
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: