Healthcare Provider Details

I. General information

NPI: 1366270506
Provider Name (Legal Business Name): CLARICE KELLI HUFFMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2024
Last Update Date: 07/22/2024
Certification Date: 07/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 NW 10TH ST
OKLAHOMA CITY OK
73106-6901
US

IV. Provider business mailing address

801 NW 10TH ST
OKLAHOMA CITY OK
73106-6901
US

V. Phone/Fax

Practice location:
  • Phone: 918-724-0134
  • Fax:
Mailing address:
  • Phone: 918-724-0134
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: