Healthcare Provider Details

I. General information

NPI: 1881309078
Provider Name (Legal Business Name): DEONKA CHATMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2023
Last Update Date: 01/23/2023
Certification Date: 01/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5818 N OSAGE DR
TULSA OK
74126-6646
US

IV. Provider business mailing address

5818 N OSAGE DR
TULSA OK
74126-6646
US

V. Phone/Fax

Practice location:
  • Phone: 480-646-0196
  • Fax:
Mailing address:
  • Phone: 480-646-0198
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number
License Number StateOK
# 3
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: