Healthcare Provider Details

I. General information

NPI: 1013017714
Provider Name (Legal Business Name): PRESTON PUBLIC SCHOOL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10165 PRINGEY AVE
PRESTON OK
74456
US

IV. Provider business mailing address

10165 PRINGEY AVE
PRESTON OK
74456
US

V. Phone/Fax

Practice location:
  • Phone: 918-756-3388
  • Fax: 918-756-2122
Mailing address:
  • Phone: 918-756-3388
  • Fax: 918-756-2122

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. DENISE MARIE GRAY
Title or Position: MEDICAID COORDINATOR
Credential:
Phone: 918-756-3388