Healthcare Provider Details

I. General information

NPI: 1144521972
Provider Name (Legal Business Name): ROCHELLE R PAYNE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ROCHELLE R PAYNE

II. Dates (important events)

Enumeration Date: 11/10/2010
Last Update Date: 07/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2010 BOREN BLVD
SEMINOLE OK
74868-2050
US

IV. Provider business mailing address

PO BOX 127 412 WEST 4TH
HOLDENVILLE OK
74848-0127
US

V. Phone/Fax

Practice location:
  • Phone: 405-382-4507
  • Fax:
Mailing address:
  • Phone: 405-221-6873
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: