Healthcare Provider Details

I. General information

NPI: 1316461213
Provider Name (Legal Business Name): MARISSA NICOLE BIGFEATHER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/01/2017
Last Update Date: 08/18/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1140 MAYBERRY DR
TAHLEQUAH OK
74464-4603
US

IV. Provider business mailing address

1145 N CEDAR AVE APT 53
TAHLEQUAH OK
74464-7141
US

V. Phone/Fax

Practice location:
  • Phone: 918-453-1108
  • Fax:
Mailing address:
  • Phone: 918-797-5204
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: