Healthcare Provider Details

I. General information

NPI: 1871454868
Provider Name (Legal Business Name): MS. DESMOND ASHLEE HATCHER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/19/2025
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 N DALTON ST
VALLIANT OK
74764-8029
US

IV. Provider business mailing address

PO BOX 673
VALLIANT OK
74764-0673
US

V. Phone/Fax

Practice location:
  • Phone: 580-203-3600
  • Fax:
Mailing address:
  • Phone: 580-203-3600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberH082894408
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: