Healthcare Provider Details

I. General information

NPI: 1295327716
Provider Name (Legal Business Name): SHAKINDA DICKENS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/05/2021
Last Update Date: 02/05/2021
Certification Date: 02/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

433 TINKER DIAGONAL ST APT 133
OKLAHOMA CITY OK
73129-8256
US

IV. Provider business mailing address

433 TINKER DIAGONAL ST APT 133
OKLAHOMA CITY OK
73129-8256
US

V. Phone/Fax

Practice location:
  • Phone: 405-609-7556
  • Fax:
Mailing address:
  • Phone: 405-609-7556
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number37V810340717
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number37V1080340717
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: