Healthcare Provider Details

I. General information

NPI: 1982568887
Provider Name (Legal Business Name): KIAMICHI ECONOMIC DEVELOPMENT DISTRICT OF OKLAHOMA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2025
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1002 HIGHWAY 2 N
WILBURTON OK
74578-3607
US

IV. Provider business mailing address

1002 HIGHWAY 2 N
WILBURTON OK
74578-3607
US

V. Phone/Fax

Practice location:
  • Phone: 918-465-2367
  • Fax: 918-465-3873
Mailing address:
  • Phone: 918-465-2367
  • Fax: 918-465-3873

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name: MRS. SAMANTHA HUMPHREYS
Title or Position: AGING DIRECTOR
Credential:
Phone: 918-465-2367