Healthcare Provider Details

I. General information

NPI: 1477383966
Provider Name (Legal Business Name): SUSAN DAWN POWERS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2024
Last Update Date: 10/25/2025
Certification Date: 10/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

76840 US-59
STILWELL OK
74960-6504
US

IV. Provider business mailing address

1108 N WHEELER AVE
SALLISAW OK
74955-2227
US

V. Phone/Fax

Practice location:
  • Phone: 918-696-2181
  • Fax:
Mailing address:
  • Phone: 918-775-5513
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number21123
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: