Healthcare Provider Details

I. General information

NPI: 1649556283
Provider Name (Legal Business Name): PATRICIA RICH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/27/2011
Last Update Date: 10/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3RD CEMETARY RD
WATTS OK
74964
US

IV. Provider business mailing address

3RD CEMETARY RD
WATTS OK
74964
US

V. Phone/Fax

Practice location:
  • Phone: 918-422-9907
  • Fax: 918-457-5540
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: