Healthcare Provider Details

I. General information

NPI: 1518441096
Provider Name (Legal Business Name): ADRIANNE ELIZABETH COLLETT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2018
Last Update Date: 09/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

302 E 6TH STREET
WELEETKA OK
74880
US

IV. Provider business mailing address

PO BOX 278
WELEETKA OK
74880-0278
US

V. Phone/Fax

Practice location:
  • Phone: 405-786-2203
  • Fax: 405-786-2625
Mailing address:
  • Phone: 405-786-2203
  • Fax: 405-786-2625

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: