Healthcare Provider Details

I. General information

NPI: 1366089898
Provider Name (Legal Business Name): HAYLEY CAUDLE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/03/2019
Last Update Date: 09/06/2023
Certification Date: 09/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 UNITED FOUNDERS BLVD STE 104
OKLAHOMA CITY OK
73112-3927
US

IV. Provider business mailing address

1724 MATTERN DR
OKLAHOMA CITY OK
73118-2206
US

V. Phone/Fax

Practice location:
  • Phone: 405-254-3994
  • Fax:
Mailing address:
  • Phone: 405-921-3414
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-19-96839
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateOK
# 3
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: