Healthcare Provider Details

I. General information

NPI: 1063180750
Provider Name (Legal Business Name): OKIES CLINICAL SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2021
Last Update Date: 09/22/2021
Certification Date: 09/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1050 RUTLEDGE PIKE
BLAINE TN
37709-3027
US

IV. Provider business mailing address

1050 RUTLEDGE PIKE
BLAINE TN
37709-3027
US

V. Phone/Fax

Practice location:
  • Phone: 423-200-6966
  • Fax: 865-932-7775
Mailing address:
  • Phone: 423-200-6966
  • Fax: 865-932-7775

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MICAH CRAINE
Title or Position: OWNER/AUTHORIZED OFFICIAL
Credential: PHARMD
Phone: 423-200-6966