Healthcare Provider Details

I. General information

NPI: 1447594684
Provider Name (Legal Business Name): KANDACE BECK DOULA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/10/2012
Last Update Date: 11/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 S MUSTANG RD #1303
YUKON OK
73099-0306
US

IV. Provider business mailing address

2000 S MUSTANG RD #1303
YUKON OK
73099-0306
US

V. Phone/Fax

Practice location:
  • Phone: 405-401-8058
  • Fax:
Mailing address:
  • Phone: 405-401-8058
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: