Healthcare Provider Details

I. General information

NPI: 1679410922
Provider Name (Legal Business Name): AMELIA DAWN RAKESTRAW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2026
Last Update Date: 05/04/2026
Certification Date: 05/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1803 S WOOD DR
OKMULGEE OK
74447-6825
US

IV. Provider business mailing address

1803 S WOOD DR
OKMULGEE OK
74447-6825
US

V. Phone/Fax

Practice location:
  • Phone: 918-756-9250
  • Fax: 918-756-9187
Mailing address:
  • Phone: 918-756-9250
  • Fax: 918-756-9187

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: